对于左心室外流通道阻塞的Kono-Rastan和修改后的Kono的晚期结果

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Elaine M Griffeth¹, Joseph A Dearani¹, Kenneth R Hassler¹

¹Department of Cardiovascular Surgery, Mayo Clinic, Rochester, Minnesota.

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|July 21, 2023

概括

随着时间的推移,Kono-Rastan和经过修改的Kono程序的长期随访显示左心室外流通道 (LVOT) 的反复阻塞. 尽管保持了心脏功能,但在这些复杂的手术后,年轻患者的晚期存活率仍然很差.

科学领域:

心血管外科心血管外科
儿童心脏病学儿童心脏病学
遗传性心脏病是一种先天性心脏病.

背景情况:

确定了Kono-Rastan和修改后的Kono程序的早期结果.
这些复杂的左心室外流通道 (LVOT) 阻塞手术的长期临床和心声学结果在很大程度上仍未确定.

研究的目的:

检查经过Kono-Rastan和修改Kono手术的患者的长期临床和心声学结果.
为了确定与这种患者群体的死亡率相关的风险因素.

主要方法:

92名接受Kono-Rastan或修改Kono治疗复杂LVOT阻塞的患者的回顾性审查 (1980-2021年).
罗斯-康诺手术因有限的腹腔切除而被排除在外.
对临床数据,心声回声学参数,再手术率和整体存活率的分析.

主要成果:

随访时间中位数为12年. 大动脉/LVOT平均梯度从1年后的13 mm Hg增加到10年后的25 mm Hg.
在10年后,Kono-Rastan的自由度为58.4%,而修改后的Kono则为41.7%.
15年的总生存率为65.5%. 死亡风险因素包括年龄较大,NYHA III/IV类,心肺绕道时间较长和多层次的LVOT阻塞.

结论:

随着时间的推移,在Kono-Rastan和修改后的Kono程序中发生反复的LVOT阻塞.
尽管保持了左心室缩功能,但这种年轻患者群体的晚期整体存活率很差.
这些发现凸显了长期监测和潜在的重新干预的必要性.

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