动脉导管未闭患者经导管封堵术后的长期随访
Long term follow-up of patients with patent ductus arteriosus after transcatheter closure.
作者信息
Peng Yue, Cheng Zhenli, Zhang Yan, Yi Qijian
机构信息
Department of Cardiovascular Medicine, Children's Hospital of Chongqing Medical University, National Clinical Research Center for Child Health and Disorders, Ministry of Education Key Laboratory of Child Development and Disorders, Chongqing, 400014, China.
Chongqing Key Laboratory of Pediatrics, Chongqing, 400014, China.
出版信息
Pediatr Res. 2025 Feb;97(3):1122-1126. doi: 10.1038/s41390-024-03317-x. Epub 2024 Jun 14.
BACKGROUND
To investigate the concurrent, long-term, and future adverse events and assess the trend of adverse events in pediatric patients with patent ductus arteriosus (PDA) after transcatheter closure.
METHODS
A total of 1590 patients underwent transcatheter PDA closure were enrolled, including 465 patients (median age = 22 months) in the training group and 1125 patients in the validation group. Logistic regression analysis was used to assess independent risk factors associated with concurrent adverse events after closure. The chi-square test was used to evaluate the 5-year follow-up trend.
RESULTS
Multivariable logistic regression analysis indicated that low age, female, and high pulmonary end diameter were independent risk factors for concurrent adverse events after closure. For patients without concurrent adverse events and for those who with concurrent adverse events but return to normal, the Chi-square test showed no abnormal results at the 5-year follow-up. Furthermore, the follow-up data of the validation group were not significantly different from those of the training group.
CONCLUSION
The value of long-term follow-up of children may be limited for those who did not have a concurrent adverse event after closure nor for those who had a concurrent adverse event after closure but returned to normal during the 5-year follow-up period.
IMPACT
Follow-up monitoring of adverse events tended to be recommended in pediatric patients with PDA after transcatheter closure. However, follow-up in these pediatric patients is expensive and there is a risk of sedation for echocardiography examination frequently. ·Patients who had no concurrent adverse events after closure did not show any abnormality at 5-year follow-up. ·Most of the patients who had concurrent adverse events after closure returned to normal at 5-year follow-up. The value of long-term follow-up may be limited for the above patients after transcatheter PDA closure.
背景
探讨动脉导管未闭（PDA）患儿经导管封堵术后的即刻、长期及远期不良事件，并评估不良事件的发展趋势。
方法
共纳入1590例行经导管PDA封堵术的患者，其中训练组465例（中位年龄=22个月），验证组1125例。采用Logistic回归分析评估封堵术后即刻不良事件的独立危险因素。采用卡方检验评估5年随访趋势。
结果
多变量Logistic回归分析表明，低年龄、女性及肺动脉末端直径增大是封堵术后即刻不良事件的独立危险因素。对于无即刻不良事件的患者以及有即刻不良事件但恢复正常的患者，卡方检验显示5年随访时无异常结果。此外，验证组的随访数据与训练组无显著差异。
结论
对于封堵术后无即刻不良事件以及有即刻不良事件但在5年随访期内恢复正常的儿童，长期随访的价值可能有限。
影响
推荐对经导管封堵术后的PDA患儿进行不良事件的随访监测。然而，这些患儿的随访费用高昂，且频繁进行超声心动图检查存在镇静风险。·封堵术后无即刻不良事件的患者在5年随访时未显示任何异常。·大多数封堵术后有即刻不良事件的患者在5年随访时恢复正常。对于上述经导管PDA封堵术后的患者，长期随访的价值可能有限。
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