下大动脉狭窄的手术纠正后的中长期结果:27年的经验
Dushan Bandara1, Gananjay G Salve1, Supreet P Marathe1
1Heart Centre for Children, The Children's Hospital at Westmead & The Sydney Children's Hospital at Randwick, Sydney, Australia.
概括
由于手术前的梯度和双主动脉受到影响,对亚动脉狭窄 (SAS) 的重新手术很常见. 大多数复发需要进一步的手术,而大动脉反仍然是温和的.
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:
- 下狭窄症 (SAS) 是儿童左心室外流通道阻塞的重要原因.
- 经过手术纠正后的长期结果和复发预测因素对于患者管理至关重要.
研究的目的:
- 评估患者的中期和长期的外科治疗结果.
- 确定初级手术修复后重新干预和复发的预测因素.
主要方法:
- 在1990年4月至2016年8月期间为SAS进行手术的120名患者的回顾性审查.
- 排除患有主要相关疾病的患者,如大动脉门阻塞.
- 卡普兰-梅尔分析,日志级别测试和考克斯回归被用来评估重新干预和复发预测的时间.
主要成果:
- 随访时间中位数为13年,无需重新干预的程度很高 (10年后90%).
- 复发发生在18%的患者中,15人需要重新干预,通常是激进的.
- 更高的手术前峰值左心室外流通道梯度和双主动脉是重新干预的重要预测因素.
结论:
- 对复发性SAS的重新干预是常见的,并由术前因素预测.
- 双主动脉是重新干预的强有力的预测因素.
- 大动脉反是常见的后果,但通常保持温和.
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