Shentu Jin, Zhang Mingjie, Xu Zhuoming, Wen Chen, Zhang Hao, Zhu Zhongqun, Chen Huiwen, Shi Guocheng
Department of Cardio-thoracic Surgery, Congenital Heart Center, Shanghai Children's Medical Center, School of Medicine Shanghai Jiao Tong University Shanghai China.
Clinical Research Center, Shanghai Children's Medical Center, School of Medicine Shanghai Jiao Tong University Shanghai China.
J Am Heart Assoc. 2025 Feb 18;14(4):e036911. doi: 10.1161/JAHA.124.036911. Epub 2025 Feb 19.
Recurrent pulmonary vein stenosis (PVS) following surgical repair of total anomalous pulmonary venous connection is associated with poor prognosis. Preclinical studies have shown that use of an angiotensin receptor blocker can attenuate intimal hyperplasia; notwithstanding, its clinical utility is of uncertain benefit.
This single-center study included patients undergoing total anomalous pulmonary venous connection repair in 2020 to 2021. Since August 2020, patients have been considered for valsartan therapy early after operation. Contemporaneous participants were subcategorized into study versus control groups based on valsartan exposure. Patients in the control group were treated with the same protocolized algorithm except valsartan administration. The primary end point was postoperative PVS (PPVS) progression.
Overall, 104 patients operated on at a median age of 1.3 months were included (valsartan group: 25 versus control group: 79). The baseline characteristics were similar between the 2 groups. Within a median follow-up of 28.6 months, 27 patients developed PPVS noted by echocardiography and computed tomography angiography, among which 22 with clinical PPVS underwent reoperations. No between-group difference was observed in the incidence of initial PPVS (=0.80, Cohen's h=0.06 [95% CI, -0.38 to 0.50]) and reoperation (=0.46, Cohen's h=-0.18[ 95% CI, -0.65 to 0.29]); however, patients in the valsartan group had a significantly lower risk of PPVS progression (=0.019, Cohen's h=-1.12 [95% CI, -1.66 to -0.57]) and subsequent PPVS progression after reoperation (=0.011, Cohen's h=-1.71 [95% CI, -2.61 to -0.82]) compared with the control group. PPVS-related death was observed in 9 cases (11.4%) in the control group versus none (0%) in the valsartan group. No adverse event related to valsartan occurred in this series.
Early use of valsartan after total anomalous pulmonary venous connection surgery appears to potentially be a feasible and effective adjunct to reoperation in treating pediatric acquired PVS.
完全性肺静脉异位连接手术修复后复发性肺静脉狭窄（PVS）与预后不良相关。临床前研究表明，使用血管紧张素受体阻滞剂可减轻内膜增生；尽管如此，其临床效用的获益尚不确定。
这项单中心研究纳入了2020年至2021年接受完全性肺静脉异位连接修复的患者。自2020年8月起，患者在术后早期即被考虑接受缬沙坦治疗。同期参与者根据是否接触缬沙坦分为研究组和对照组。对照组患者接受相同的标准化方案治疗，但不给予缬沙坦。主要终点是术后PVS（PPVS）进展。
总体而言，纳入了104例中位年龄为1.3个月的手术患者（缬沙坦组：25例；对照组：79例）。两组的基线特征相似。在中位随访28.6个月期间，27例患者经超声心动图和计算机断层血管造影检查发现发生了PPVS，其中22例临床诊断为PPVS的患者接受了再次手术。初始PPVS的发生率（=0.80，科恩h=0.06 [95% CI，-0.38至0.50]）和再次手术的发生率（=0.46，科恩h=-0.18 [95% CI，-0.65至0.29]）在两组之间未观察到差异；然而，与对照组相比，缬沙坦组患者PPVS进展的风险显著较低（=0.019，科恩h=-1.12 [95% CI，-1.66至-0.57]），再次手术后后续PPVS进展的风险也显著较低（=0.011，科恩h=-1.71 [95% CI，-2.61至-0.82]）。对照组有9例（11.4%）发生PPVS相关死亡，而缬沙坦组无（0%）。本系列中未观察到与缬沙坦相关的不良事件。
完全性肺静脉异位连接手术后早期使用缬沙坦似乎可能是治疗小儿获得性PVS再次手术的一种可行且有效的辅助手段。
