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在SVR试验中的6年无移植生存和干预
Jane W Newburger1, Lynn A Sleeper2, J William Gaynor3
1Boston Children's Hospital and Harvard Medical School, MA (J.W.N., L.A.S., C.D.-M.). jane.newburger@cardio.chboston.org.
Circulation
|February 14, 2018
概括
在左心缩综合征中,尽管早期有好处,但右心室到肺动脉分流 (RVPAS) 与修改后的Blalock- Taussig分流相比没有显著改善6年无移植存活率. 这两种突变导致了严重的并发症.
科学领域:
- 儿童心脏病学
- 遗传性心脏手术
- 单心室生理学
背景情况:
- 在单心室重建 (SVR) 试验中,与修改的Blalock- Taussig分离器相比,与右心室至肺动脉分离器 (RVPAS) 相比,对左心脏和相关综合征的1年无移植生存率更好.
- 这项研究将随访时间延长到6年,以比较这两种手术方法的长期无移植存活率和其他结果.
研究的目的:
- 在SVR试验中,将使用RVPAS治疗的左心低质综合征患者与修改的Blalock- Taussig分离器之间的6年无移植生存期和其他临床结果进行比较.
- 分析分离型对死亡率,移植需要和不同手术阶段的干预措施的长期影响.
主要方法:
- 分析了在SVR试验中随机选择的549名患者.
- 年度医疗记录审查,电话采访和死亡指数用于收集病史和生存数据.
- 统计分析包括日志等级测试和危险比率计算,以比较RVPAS和修改的Blalock-Taussig分离组之间的结果.
主要成果:
- 在RVPAS (64%) 和修改后的Blalock- Taussig (59%) 组之间,无移植生存没有显著差异 (P=0. 25).
- 虽然RVPAS在第二阶段手术前有利于生存,但这种效应在后期没有持续. 患有RVPAS的患者需要显著更多的导管干预 (0. 38对0. 23/患者年,P<0. 001),特别是在II阶段和Fontan手术之间.
- 并发症的发生率相似;在6年内,20%的患者发生了血栓事件,17%的患者发作.
结论:
- 在低可塑性左心综合征中,RVPAS对修改后的Blalock- Taussig分离器的初始1年生存益处在6年后没有维持.
- 虽然RVPAS在统计学上没有显著性,但它显示出更高的无移植生存率. 然而,它与对导管干预的需求增加有关.
- 这两种手术策略都会导致严重的长期并发症,
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