原发性缩窄球囊血管成形术与复发性主动脉梗阻的急性结果相当。先天性异常瓣膜成形术和血管成形术（VACA）注册研究人员。

Acute results of balloon angioplasty of native coarctation versus recurrent aortic obstruction are equivalent. Valvuloplasty and Angioplasty of Congenital Anomalies (VACA) Registry Investigators.

作者信息

McCrindle B W, Jones T K, Morrow W R, Hagler D J, Lloyd T R, Nouri S, Latson L A

机构信息

Department of Pediatrics, Hospital for Sick Children, University of Toronto, Ontario, Canada.

出版信息

J Am Coll Cardiol. 1996 Dec;28(7):1810-7. doi: 10.1016/s0735-1097(96)00379-8.

DOI:10.1016/s0735-1097(96)00379-8

PMID:8962571

Abstract

OBJECTIVES

This study sought to compare the immediate results and risk factors for suboptimal outcomes of percutaneous balloon angioplasty for native versus recurrent aortic obstruction.

BACKGROUND

Some cardiology centers have been reluctant to adopt balloon angioplasty for treatment of native aortic coarctation, while advocating balloon angioplasty over an operation for treatment of postsurgical or recurrent aortic obstruction.

METHODS

Acute results were analyzed from 970 procedures (422 native and 548 recurrent lesions) performed between 1982 and 1995 in 907 patients from 25 centers. An acute suboptimal outcome was defined as one or more of the following: residual systolic pressure gradient > or = 20 mm Hg, residual proximal to distal systolic pressure ration > or = 1.33 or a major complication (death, aortic transmural tear, stroke).

RESULTS

Bal loon angioplasty significantly (p = 0.0001) increased lesion diameter fo r both native (mean [+/= SD] 128 +/= 94%) and recurrent aortic obstruction (97 +/= 87%), with a significantly greater increase in the native group (p = 0.0001). A reduction in systolic pressure gradients was significant in both groups (p = 0.0001), but slightly higher (p = 0.01) for native (-74 +/- 24%) versus recurrent obstruction (-70 +/- 31%). Death associated with angioplasty was reported in 0.7% of patients with native and in 0.7% of patients with recurrent lesions (p = 1.00). An acute suboptimal outcome was noted with angioplasty in 19% of native and in 25% of recurrent lesions (p = 0.04). Significant independent risk factors included higher preangioplasty systolic gradient (odds ratio [OR] 1.39/10-mm Hg increment; 95% confidence interval [CI] 1.28 to 1.50, p = 0.0001), earlier study date (OR 0.92/1-year increment, 95% CI 1.02 to 1.26, p = 0.02) and recurrent obstruction (OR 1.39 vs. native lesions, 95% CI 1.00 to 1.94, p = 0.05).

CONCLUSIONS

Acute results and complications of balloon angioplasty of native coarctation appear to be equivalent or slightly superior to those of recurrent aortic obstructions.

摘要

目的

本研究旨在比较经皮球囊血管成形术治疗原发性与复发性主动脉梗阻的近期结果及预后欠佳的危险因素。

背景

一些心脏病中心不愿采用球囊血管成形术治疗原发性主动脉缩窄，而主张采用球囊血管成形术而非手术治疗术后或复发性主动脉梗阻。

方法

分析了1982年至1995年间在25个中心对907例患者进行的970例手术（422例原发性病变和548例复发性病变）的急性结果。急性预后欠佳定义为以下一项或多项：残余收缩压梯度≥20 mmHg、残余近端与远端收缩压比值≥1.33或发生重大并发症（死亡、主动脉全层撕裂、中风）。

结果

球囊血管成形术使原发性（平均[±标准差]128±94%）和复发性主动脉梗阻（97±87%）的病变直径均显著增加（p = 0.0001），原发性组增加更为显著（p = 0.0001）。两组收缩压梯度均显著降低（p = 0.0001），但原发性梗阻（-74±24%）较复发性梗阻（-70±31%）略高（p = 0.01）。原发性病变患者和复发性病变患者中与血管成形术相关的死亡报告率均为0.7%（p = 1.00）。血管成形术治疗原发性病变时，19%出现急性预后欠佳；治疗复发性病变时，25%出现急性预后欠佳（p = 0.04）。显著的独立危险因素包括血管成形术前较高的收缩压梯度（优势比[OR]为1.39/10 mmHg增量；95%置信区间[CI]为1.28至1.50，p = 0.0001）、较早的研究日期（OR为0.92/1年增量，95%CI为1.02至1.26，p = 0.02）和复发性梗阻（与原发性病变相比，OR为1.39，95%CI为1.00至1.94，p = 0.05）。