在动脉切换手术后晚期的新动脉和根部手术的结果
Michael Z L Zhu1, Tyson A Fricke1, Edward Buratto1
1Department of Cardiac Surgery, The Royal Children's Hospital, Melbourne, Australia; Department of Paediatrics, The University of Melbourne, Melbourne, Australia; Heart Research Group, Murdoch Children's Research Institute, Melbourne, Australia.
The Journal of thoracic and cardiovascular surgery
|September 27, 2023
概括
在动脉切换手术 (ASO) 30年后,超过10%的患者需要对新动脉/根进行重新手术. 双门和某些先天性心脏缺陷增加了重新手术的风险. 未来的技术可能会减少对主动脉置换 (AVR) 的需要.
科学领域:
- 心血管外科心血管外科
- 遗传性心脏病是一种先天性心脏病.
- 儿童心脏病学 儿童心脏病学
背景情况:
- 新大动脉根扩张和回是动脉切换手术 (ASO) 后日渐被认可的晚期并发症.
- 了解新动脉根或门重新操作的长期结果对于患者管理至关重要.
研究的目的:
- 评估接受ASO的患者中新动脉根或门重新操作的患病率和结果.
- 确定重复手术的预测因素,并评估长期无需重复手术和大动脉置换 (AVR) 的情况.
主要方法:
- 在1983年至2015年期间在一个机构接受ASO的782名双心室循环患者的回顾性分析.
- 分析了随访数据,以确定新动脉/根重新手术的发生率,执行的手术类型以及重新手术的预测因素.
- 卡普兰-梅尔生存分析被用来估计免于重新手术和免于AVR的自由.
主要成果:
- 在782名晚期ASO幸存者中,6.0% (47名患者) 在ASO后15.2年中位数接受了60次新动脉/根的重复手术.
- 常见的手术包括机械本塔尔手术,大动脉修复,机械AVR和节省根部置换.
- 重复手术的预测因素包括双门,陶西格-宾异常,先前的肺动脉带带,以及ASO前的左心室外流通道阻塞.
- 在ASO后30年,新动脉或根重新操作的自由率为88.5%;在25年后,重新操作后的AVR自由率为43.2%.
结论:
- 在ASO30年后,新动脉或根部再操作的累积发病率超过10%,ASO.
- 识别风险因素可以帮助预测哪些患者可能需要未来的干预措施.
- 了解新动脉缺陷的进展和改进的修复技术可能会减少长期需要AVR的需求.
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