Division of Cardiac Surgery, Department of Surgery, Mazankowski Alberta Heart Institute University of Alberta Edmonton Alberta Canada.
Division of Cardiology, Department of Medicine, Mazankowski Alberta Heart Institute University of Alberta Edmonton Alberta Canada.
J Am Heart Assoc. 2024 Jun 18;13(12):e033686. doi: 10.1161/JAHA.123.033686. Epub 2024 Jun 14.
Sinus venosus atrial septal defect (SVASD) is a rare congenital cardiac anomaly comprising 5% to 10% of all atrial septal defects. Although surgical closure is the standard treatment for SVASD, data on outcomes have been confined to small cohorts. Thus, we conducted a systematic review of the outcomes of SVASD repair.
The primary outcome was death. Secondary outcomes encompassed atrial fibrillation, sinus node dysfunction, pacemaker insertion, cerebrovascular accident, reoperation, residual septal defect, superior vena cava obstruction, and reimplanted pulmonary vein obstruction. Pooled incidences of outcomes were calculated using a random-effects model. Forty studies involving 1320 patients who underwent SVASD repair were included. The majority were male patients (55.4%), with 88.0% presenting with associated anomalous pulmonary venous connection. The weighted mean age was 18.6±12.5 years, and the overall weighted mean follow-up period was 8.6±10.4 years. The in-hospital mortality rate was 0.24%, with a 30-day mortality rate of 0.5% reported in 780 patients. Incidences of atrial fibrillation, sinus node dysfunction, pacemaker insertion, and cerebrovascular accident over the long-term follow-up were 3.3% (2.18%-4.93%), 6.5% (5.09%-8.2%), 2.23% (1.34%-3.57%), and 2.03% (0.89%-2.46%) respectively. Reoperation occurred in 1.36% (0.68%-2.42%) of surgeries, residual septal defect in 1.34% (0.69%-2.42%), superior vena cava obstruction in 1.76% (1.02%-2.9%), and reimplanted pulmonary vein obstruction in 1.4% (0.7%-2.49%).
This is the first comprehensive analysis of outcomes following surgical repair of SVASD. The findings affirm the safety and effectiveness of surgery, establishing a reference point for evaluating emerging transcatheter therapies. Safety and efficacy profiles comparable to surgical repair are essential for widespread adoption of transcatheter treatments.
静脉窦型房间隔缺损（SVASD）是一种罕见的先天性心脏畸形，占所有房间隔缺损的 5%至 10%。尽管手术闭合是 SVASD 的标准治疗方法，但有关结果的数据仅限于小队列。因此，我们对 SVASD 修复的结果进行了系统评价。
主要结局为死亡。次要结局包括心房颤动、窦房结功能障碍、起搏器植入、脑血管意外、再次手术、残余房间隔缺损、上腔静脉阻塞和再植肺静脉阻塞。使用随机效应模型计算结局的合并发生率。纳入了 40 项涉及 1320 例接受 SVASD 修复的患者的研究。大多数患者为男性（55.4%），88.0%存在异常肺静脉连接。加权平均年龄为 18.6±12.5 岁，总体加权平均随访时间为 8.6±10.4 年。住院死亡率为 0.24%，780 例患者报告 30 天死亡率为 0.5%。长期随访中心房颤动、窦房结功能障碍、起搏器植入和脑血管意外的发生率分别为 3.3%（2.18%-4.93%）、6.5%（5.09%-8.2%）、2.23%（1.34%-3.57%）和 2.03%（0.89%-2.46%）。手术中有 1.36%（0.68%-2.42%）需要再次手术，残余房间隔缺损为 1.34%（0.69%-2.42%），上腔静脉阻塞为 1.76%（1.02%-2.9%），再植肺静脉阻塞为 1.4%（0.7%-2.49%）。
这是首次对 SVASD 手术修复后结局的全面分析。研究结果证实了手术的安全性和有效性，为评估新兴的经导管治疗方法提供了参考点。与手术修复相比具有相似的安全性和疗效特征对于广泛采用经导管治疗至关重要。
