Günther T, Mazzitelli D, Haehnel C J, Holper K, Sebening F, Meisner H
Department of Cardiovascular Surgery, German Heart Center, Munich.
Ann Thorac Surg. 1998 Mar;65(3):754-9; discussion 759-60. doi: 10.1016/s0003-4975(98)00028-9.
We analyzed data from 320 patients to evaluate the impact of different preoperative, operative, and postoperative factors on the outcome after repair of complete atrioventricular septal defect.
Between October 1974 and December 1995, 320 patients with complete atrioventricular septal defect not associated with major cardiac anomalies were operated on. Two hundred seventy-four patients underwent total repair. Sixty-three patients (23%) were less than 6 months old. One hundred ninety-eight (72.2%) underwent primary repair. Seventy-six patients (27.7%) had a previous palliative operation.
Operative mortality in patients who underwent primary repair decreased from 17.6% (1974 to 1979) to 5.0% (1990 to 1995) despite an increase in the number of patients younger than 6 months. In patients undergoing a two-stage procedure operative mortality was 3.9% (late mortality, 7.9%). Young age (<6 months) was an incremental risk factor (p = 0.008) for operative mortality in the early study period. Coarctation of the aorta (p = 0.02) and severe dysplastic left atrioventricular valve (p = 0.001) were associated with a higher risk for operative mortality. Freedom from reoperation at 10 years was 82.5% +/- 3.8%.
In patients with complete atrioventricular septal defect, primary repair is the treatment of choice and can be accomplished with good results. In our experience over a period of more than 20 years, earlier date of operation, young age (<6 months), dysplastic left atrioventricular valve, and coexisting coarctation were incremental risk factors for hospital death. The presence of a previously placed pulmonary artery band did not alter the outcome of repair. The reconstructed atrioventricular valve shows a good and long-lasting performance.
我们分析了320例患者的数据，以评估不同的术前、术中和术后因素对完全性房室间隔缺损修复术后结局的影响。
1974年10月至1995年12月期间，对320例不伴有严重心脏畸形的完全性房室间隔缺损患者进行了手术。274例患者接受了完全修复。63例患者（23%）年龄小于6个月。198例（72.2%）接受了一期修复。76例患者（27.7%）曾接受过姑息性手术。
尽管年龄小于6个月的患者数量有所增加，但一期修复患者的手术死亡率从1974年至1979年的17.6%降至1990年至1995年的5.0%。在接受两阶段手术的患者中，手术死亡率为3.9%（晚期死亡率为7.9%）。在早期研究阶段，年轻（<6个月）是手术死亡率的一个递增风险因素（p = 0.008）。主动脉缩窄（p = 0.02）和严重发育异常的左房室瓣（p = 0.001）与较高的手术死亡风险相关。10年无再次手术率为82.5%±3.8%。
对于完全性房室间隔缺损患者，一期修复是首选治疗方法，且可取得良好效果。根据我们20多年的经验，手术日期早、年龄小（<6个月）、左房室瓣发育异常和并存主动脉缩窄是医院死亡的递增风险因素。先前放置的肺动脉带的存在并未改变修复结局。重建的房室瓣显示出良好且持久的性能。
