Rizzoli G, Mazzucco A, Brumana T, Valfre C, Rubino M, Rocco F, Daliento L, Frescura C, Gallucci V
Br Heart J. 1984 Sep;52(3):258-65. doi: 10.1136/hrt.52.3.258.
Between 1 January 1975 and 31 December 1982, 111 patients with atrioventricular septal defect underwent surgical repair. Of these, 43 had the complete, 11 the intermediate, and 57 the partial form. The postoperative mortality rate was 37%, 9%, and 6% respectively. To determine which factors were independently responsible for the operative risk multivariate analysis of the surgical mortality was applied simultaneously to all three forms of the malformation. The form of defect, although strongly influencing the natural history and clinical presentation, was not by itself an operative risk factor. The risk was related primarily to failure to obtain a well functioning atrioventricular valve, to the presence of left ventricular dominance, to the degree of pulmonary vascular resistance, and, finally, to the technique of reconstructing a two leaflet left atrioventricular valve. The small size of the patient was also a significant incremental risk factor, but if the other factors were not unfavorable good results could be achieved in small infants with mortality rates less than 10%. Multivariate analysis showed that severe postoperative left atrioventricular valve malfunction was related to the technique used to reconstruct a "normal" two leaflet left atrioventricular valve. These findings support the policy of reconstructing the left atrioventricular valve as a three leaflet valve. Nevertheless, the implicit beneficial effect of this technique has not as yet proved to be statistically significant.
1975年1月1日至1982年12月31日期间，111例房室间隔缺损患者接受了手术修复。其中，43例为完全型，11例为中间型，57例为部分型。术后死亡率分别为37%、9%和6%。为确定哪些因素独立影响手术风险，对所有三种畸形类型同时进行了手术死亡率的多因素分析。缺损类型虽然对自然病程和临床表现有很大影响，但其本身并非手术风险因素。风险主要与未能获得功能良好的房室瓣、左心室优势的存在、肺血管阻力程度以及最后与重建双叶式左房室瓣的技术有关。患者体型小也是一个显著的额外风险因素，但如果其他因素并非不利，小婴儿也可取得良好结果，死亡率低于10%。多因素分析表明，严重的术后左房室瓣功能障碍与重建“正常”双叶式左房室瓣所采用的技术有关。这些发现支持将左房室瓣重建为三叶瓣的策略。然而，该技术的潜在有益效果尚未被证明具有统计学意义。
