Seirafi P A, Warner K G, Geggel R L, Payne D D, Cleveland R J
Division of Cardiothoracic Surgery, New England Medical Center and Tufts University School of Medicine, Boston, Massachusetts 02111, USA.
Ann Thorac Surg. 1998 Oct;66(4):1378-82. doi: 10.1016/s0003-4975(98)00595-5.
Recent surgical reports on coarctation of the aorta have primarily focused on the relative merits of various operative techniques. However, appropriate timing for elective repair remains unclear.
In a retrospective analysis we examined the surgical outcomes in 176 consecutive patients undergoing repair of coarctation of the aorta in our institution over a 25-year period. Ninety-nine percent of the patients had follow-up for a median of 7.5 years.
A total of 13 patients have died (7.4% overall mortality). Nine of these patients had associated complex intracardiac anomalies. There was no mortality in the 113 patients with isolated coarctation. Residual or recurrent coarctation occurred in 27 patients (15.3%). The age at operation and the type of surgical repair did not have an effect on the incidence of recurrence. Persistent or late hypertension was identified in 18 of the 107 patients who have been followed up for more than 5 years (16.8%). A total of 48 patients operated on during infancy have been followed up for more than 5 years. Only 2 have developed late hypertension (4.2%). Both of these patients had recurrence. In contrast, 16 of the 59 patients operated on after a year of age had late hypertension (27.1%).
To minimize the risk of persistent hypertension, elective repair of coarctation should be performed within the first year of life.
近期关于主动脉缩窄的外科手术报告主要集中在各种手术技术的相对优点上。然而，择期修复的合适时机仍不明确。
在一项回顾性分析中，我们检查了本机构25年间连续176例接受主动脉缩窄修复手术患者的手术结果。99%的患者获得随访，中位随访时间为7.5年。
共有13例患者死亡（总死亡率7.4%）。其中9例患者合并复杂的心内畸形。113例单纯主动脉缩窄患者无死亡。27例患者（15.3%）出现残余或复发性主动脉缩窄。手术年龄和手术修复类型对复发率无影响。在107例随访超过5年的患者中，18例（16.8%）发现持续性或晚期高血压。共有48例婴儿期接受手术的患者随访超过5年。只有2例（4.2%）出现晚期高血压。这2例患者均有复发。相比之下，59例1岁以后接受手术的患者中有16例（27.1%）出现晚期高血压。
为使持续性高血压风险降至最低，主动脉缩窄的择期修复应在出生后第一年内进行。
