Lv Lizhi, Sun Yuekun, Zhang Simeng, Zhi Aihua, Wang Cheng, Wang Qiang
Department of Pediatric Cardiac Center, Beijing Anzhen Hospital, Capital Medical University, 100029 Beijing, China.
Department of Cardiac Surgery, Yunnan Fuwai Cardiovascular Hospital, 650102 Kunming, Yunnan, China.
Rev Cardiovasc Med. 2024 Oct 25;25(10):384. doi: 10.31083/j.rcm2510384. eCollection 2024 Oct.
The appropriate age for surgical repair of asymptomatic congenital supravalvular aortic stenosis (SVAS) is still unknown. The purpose of this research was to assess the safety and effectiveness of various operation ages when managing SVAS.
Consecutive asymptomatic SVAS pediatric patients in the Beijing Fuwai and Yunnan Fuwai hospitals over a period of 18 years were retrospectively analyzed. Patients were classified as follows: age <2.0 years (y) (n = 84), 2.0-5.0 y (n = 72), and >5.0 y (n = 92). The primary safety endpoint was in-hospital death or extracorporeal membrane oxygenation (ECMO) needed. The primary effectiveness outcome was re-operation or restenosis during follow-up. To calculate the hazard ratios (HR), Cox regression with inverse probability of treatment weighted was utilized.
At the time of surgery, the median age of the 248 patients that were included was 4 y (interquartile range (IQR): 1.8-6.5). For the primary safety outcome, 7 (8.3%) patients in the age <2.0 y group had in-hospital death or ECMO needed, while no patients in the age 2.0-5.0 y and age>5.0 y groups ( = 0.001). The median follow-up was 25.5 months (IQR: 7.0-59.0). Compared with the age 2.0-5.0 y group, the age <2.0 y group and age >5.0 y group had a higher risk of re-operation or restenosis (age <2.0 y, HR = 3.27, 95% CI 1.25-8.60; age >5.0 y, HR = 2.87, 95% CI 1.19-6.91).
Asymptomatic children with SVAS without other cardiovascular abnormalities should be considered for delayed surgical intervention until 2 years of age, and then surgery should be conducted as soon as possible. Children with severe symptoms should undergo surgery immediately, regardless of age.
ChiCTR2300067851, https://www.chictr.org.cn/showproj.html?proj=177491.
无症状先天性主动脉瓣上狭窄（SVAS）手术修复的合适年龄仍不清楚。本研究的目的是评估治疗SVAS时不同手术年龄的安全性和有效性。
回顾性分析北京阜外医院和云南阜外医院18年间连续的无症状SVAS儿科患者。患者分为以下几组：年龄<2.0岁（n = 84），2.0 - 5.0岁（n = 72），>5.0岁（n = 92）。主要安全终点是住院死亡或需要体外膜肺氧合（ECMO）。主要有效性结局是随访期间再次手术或再狭窄。为计算风险比（HR），采用加权治疗逆概率的Cox回归。
手术时，纳入的248例患者的中位年龄为4岁（四分位间距（IQR）：1.8 - 6.5）。对于主要安全结局，<2.0岁组有7例（8.3%）患者住院死亡或需要ECMO，而2.0 - 5.0岁组和>5.0岁组均无患者出现这种情况（P = 0.001）。中位随访时间为25.5个月（IQR：7.0 - 59.0）。与2.0 - 5.0岁组相比，<2.0岁组和>5.0岁组再次手术或再狭窄的风险更高（<2.0岁，HR = 3.27，95%CI 1.25 - 8.60；>5.0岁，HR = 2.87，95%CI 1.19 - 6.91）。
无症状且无其他心血管异常的SVAS儿童应考虑延迟手术干预至2岁，然后尽快进行手术。有严重症状的儿童应立即手术，无论年龄大小。
ChiCTR2300067851，https://www.chictr.org.cn/showproj.html?proj=177491
