Eldadah Osama M, Alsalmi Asseel Ali, Diraneyya Obayda M, Hrfi Abdah A, Mohammed Mohammed H A, Valls Maria L, Alghamdi Abdullah A
Department of Cardiac Sciences, King Abdulaziz Cardiac Center, Ministry of National Guard Health Affairs, Riyadh, Saudi Arabia.
King Abdullah International Medical Research Center, Riyadh, Saudi Arabia.
Ann Pediatr Cardiol. 2023 May-Jun;16(3):182-188. doi: 10.4103/apc.apc_140_22. Epub 2023 Sep 8.
Repair of aortic coarctation through left thoracotomy is the standard treatment when anatomically feasible. Long-term outcomes are well studied, including the need for reintervention. However, the timely variation in residual gradients across the repaired segment is ill-defined. The aim of this work was to study the progressive changes of estimated peak gradient (ePG) acquired by transthoracic continuous-wave Doppler echocardiography across the aortic arch after repair and to assess the role of timing of assessment and values of ePG in prediction of reintervention.
All eligible patients for this study who underwent aortic coarctation repair through left thoracotomy from 2001 to 2017 were reviewed. Details of the aortic arch dimensions and associated lesions were obtained by transthoracic echocardiography (TTE). The primary outcome was the ePG across the aortic arch after repair. Longitudinal data analyses with mixed effect modeling were used to determine independent predictors for ePGs.
A total of 312 patients were included. Median age and weight were 30 days and 4 kg, respectively. Associated lesions included ventricular septal defect (VSD) (53%), bicuspid aortic valve (53%) and mitral stenosis (25%). Over 15-years follow-up the freedom from reintervention was 92.3%, while 24 out of the 312 patients underwent reintervention (7.7%). Longitudinal data analyses of serial 2566 TTE studies were done. The graphical display showed that the ePG across coarctation area in the first postoperative TTE was the most notable difference between those who underwent reintervention and those who did not. Further testing with proportional hazard and logistic regression modeling confirmed this finding. The area under receiver operating curve statistics showed that an ePG of 25 mmHg is an optimal cutoff value for the prediction of the reintervention.
The ePG acquired in the first postoperative TTE is the most important predictor for reinterventions. The presence of VSD is associated with decreased ePGs. We propose that an ePG in the first postoperative TTE of 25 mmHg or more is a strong predictor for the need of reintervention.
在解剖结构可行的情况下，通过左胸切口修复主动脉缩窄是标准治疗方法。长期预后已得到充分研究，包括再次干预的必要性。然而，修复节段残余压差的及时变化尚不明确。本研究的目的是研究经胸连续波多普勒超声心动图测量的修复后主动脉弓估计峰值压差（ePG）的渐进变化，并评估评估时间和ePG值在预测再次干预中的作用。
回顾了2001年至2017年期间所有通过左胸切口进行主动脉缩窄修复的符合本研究条件的患者。通过经胸超声心动图（TTE）获取主动脉弓尺寸及相关病变的详细信息。主要结局指标是修复后主动脉弓的ePG。采用混合效应模型进行纵向数据分析，以确定ePG的独立预测因素。
共纳入312例患者。中位年龄和体重分别为30天和4kg。相关病变包括室间隔缺损（VSD）（53%）、二叶式主动脉瓣（53%）和二尖瓣狭窄（25%）。在15年的随访中，无需再次干预的比例为92.3%，而312例患者中有24例接受了再次干预（7.7%）。对2566项连续TTE研究进行了纵向数据分析。图形显示，术后首次TTE时缩窄区域的ePG是接受再次干预和未接受再次干预患者之间最显著的差异。通过比例风险和逻辑回归模型进一步检验证实了这一发现。受试者工作特征曲线统计的曲线下面积显示，ePG为25mmHg是预测再次干预的最佳截断值。
术后首次TTE测得的ePG是再次干预的最重要预测因素。VSD的存在与ePG降低有关。我们建议，术后首次TTE测得的ePG≥25mmHg是需要再次干预的有力预测指标。
