成年人离散性亚大风狭窄的外科结局:一个多中心研究
Denise van der Linde1, Jolien W Roos-Hesselink, Dimitris Rizopoulos
1Department of Cardiothoracic Surgery, Erasmus University Medical Center, Rotterdam, Netherlands.
Circulation
|February 22, 2013
概括
离散的静脉下狭窄手术提供了很好的生存率,但重新手术是常见的. 左心室外流通道梯度在手术后缓慢增加,轻度的大动脉反是频繁的,但通常是稳定的.
科学领域:
- 心脏病学 心脏病学
- 儿童心脏病学 儿童心脏病学
- 成年人的先天性心脏病
背景情况:
- 离散性静脉下狭窄症 (DSS) 在儿童时期呈现出不可预测的血液动力学进展和高的重新手术率.
- 关于成年期DSS的长期结果的数据有限.
- 了解成年人的结果对于整个生命周期中管理这种情况至关重要.
研究的目的:
- 为了评估在成年人中离散性静脉下狭窄症 (DSS) 的长期术后进展.
- 为了确定DSS手术后重复手术和大动脉吐进展的预测因素.
- 评估额外的肌肉切除术对重新手术风险和并发症的影响.
主要方法:
- 回顾性多中心队列研究,包括313名先前接受过DSS手术的成年患者.
- 混合效应和联合模型被用于分析DSS的术后进展,大动脉吐和重新手术率.
- 随访时间中位数为12.9年,总计5617个患者年.
主要成果:
- 左心室外流通道 (LVOT) 梯度在术后显著下降,但以每年1.31mmHg的速度增加.
- 轻度大动脉反是常见的 (68%),但通常不进展;手术前的LVOT梯度≥80 mm Hg预测中度的AR.
- 80名患者需要重新手术;女性性别和LVOT梯度进展是预测因素. 额外的肌切除术并没有降低重新手术的风险,但增加了心脏阻塞风险.
结论:
- 在DSS手术后的生存率很好,尽管复发后的重新手术并不罕见.
- 手术后的LVOT梯度缓慢增加,轻度的大动脉反是频繁的,但通常是稳定的.
- 由于缺乏益处和增加完全心脏阻塞的风险,不建议进行常规的额外肌切除术.
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