Department of Cardiac Surgery, Boston Children's Hospital, Boston, Massachusetts.
Department of Cardiology, Boston Children's Hospital, Boston, Massachusetts; Department of Biostatistics, Harvard School of Public Health, Boston, Massachusetts.
Ann Thorac Surg. 2023 Oct;116(4):796-802. doi: 10.1016/j.athoracsur.2022.05.058. Epub 2022 Jun 30.
Outcomes after total anomalous pulmonary venous connection (TAPVC) repair remain suboptimal due to recurrent pulmonary vein (PV) obstruction requiring reinterventions. We sought to develop a clinical prediction rule for PV reintervention after TAPVC repair.
Data from consecutive patients who underwent TAPVC repair at a single institution from January 1980 to January 2020 were retrospectively reviewed after Institutional Review Board approval. The primary outcome was postdischarge (late) unplanned PV surgical or transcatheter reintervention. Echocardiographic criteria were used to assess PV residual lesion severity at discharge (class 1: no residua; class 2: minor residua; class 3: major residua). Competing risk models were used to develop a weighted risk score for late reintervention.
Of 437 patients who met entry criteria, there were 81 (18.5%) reinterventions at a median follow-up of 15.6 (interquartile range, 5.5-22.2) years. On univariable analysis, minor and major PV residua, age, single-ventricle physiology, infracardiac and mixed TAPVC, and preoperative obstruction were associated with late reintervention (all P < .05). The final risk prediction model included PV residua (class 2: subdistribution hazard ratio [SHR], 4.8; 95% CI, 2.8-8.1; P < .001; class 3: SHR, 6.4; 95% CI, 3.5-11.7; P < .001), age <1 year (SHR, 3.3; 95% CI, 1.3-8.5; P = .014), and preoperative obstruction (SHR, 1.8; 95% CI, 1.1-2.8; P = .015). A risk score comprising PV residua (class 2 or 3: 3 points), age (neonate or infant: 2 points), and obstruction (1 point) was formulated. Higher risk scores were significantly associated with worse freedom from reintervention (P < .001).
A risk prediction model of late reintervention may guide prognostication of high-risk patients after TAPVC repair.
由于肺静脉（PV）再阻塞需要再次介入，全肺静脉异常连接（TAPVC）修复后的结果仍然不理想。我们试图为 TAPVC 修复后 PV 再介入制定一个临床预测规则。
经机构审查委员会批准，回顾性分析了 1980 年 1 月至 2020 年 1 月期间在一家机构接受 TAPVC 修复的连续患者的数据。主要结果是出院后（晚期）计划外 PV 手术或经导管再介入。使用超声心动图标准评估出院时的 PV 残留病变严重程度（1 级：无残留；2 级：轻微残留；3 级：严重残留）。使用竞争风险模型为晚期再干预制定加权风险评分。
在符合纳入标准的 437 名患者中，81 名（18.5%）在中位随访 15.6 年（四分位距，5.5-22.2）时进行了再介入。单变量分析显示，PV 残留、年龄、单心室生理学、心下型和混合 TAPVC 以及术前梗阻与晚期再介入相关（均 P <.05）。最终风险预测模型包括 PV 残留（2 级：亚分布危险比 [SHR]，4.8；95%CI，2.8-8.1；P <.001；3 级：SHR，6.4；95%CI，3.5-11.7；P <.001）、年龄 <1 岁（SHR，3.3；95%CI，1.3-8.5；P =.014）和术前梗阻（SHR，1.8；95%CI，1.1-2.8；P =.015）。制定了一个包含 PV 残留（2 级或 3 级：3 分）、年龄（新生儿或婴儿：2 分）和梗阻（1 分）的风险评分。较高的风险评分与较差的免于再介入的自由显著相关（P <.001）。
晚期再介入风险预测模型可以指导 TAPVC 修复后高危患者的预后。
