儿童和婴儿的罗斯手术:一个系统的综述与聚合分析
Nabil Dib1,2, Walid Ben Ali1, Thierry Ducruet3
1Department of Medicine, Montreal Heart Institute, Université de Montréal, Montreal, Québec, Canada.
CJC pediatric and congenital heart disease
|July 29, 2024
概括
罗斯手术在患有先天性大动脉狭窄症的儿童中提供了适度的生存率. 然而,接受这种手术的婴儿面临着明显更高的死亡率和重新干预的风险,强调需要仔细考虑.
科学领域:
- 儿科心脏手术 儿科心脏手术
- 遗传性心脏病是一种先天性心脏病.
- 大动脉门的更换
背景情况:
- 罗斯手术是对先天性大动脉狭窄的一种手术选择,用肺自身移植代替大动脉.
- 罗斯手术对儿童,特别是婴儿的结果尚未得到充分证实.
研究的目的:
- 系统地审查和分析儿童在罗斯手术后的生存率和再干预率.
- 具体评估婴儿 (1岁以下) 与老年儿童相比的结果.
主要方法:
- 对包括2737名患者在内的25项研究进行了系统审查和聚合分析,这些研究遵循了PRISMA标准.
- 从生命表中提取推断的个体患者数据,以评估主要终点:早期 (≤30天) 和晚期 (>30天) 死亡率.
- 二级终点包括对右心室外流通道和肺自身移植无需重新干预,并对婴儿进行敏感性分析.
主要成果:
- 总体汇总早期生存率为96.0%,但对婴儿来说显著低于86.8%,为86.8%.
- 综合的10年生存率为整体91.1%,婴儿为79.3%.
- 与非婴儿儿童相比,婴儿的死亡率 (HR:3.38) 和再干预率 (51.2%的RVOT) 显著更高,年龄较小与结果较差密切相关.
结论:
- 罗斯手术在儿科患者群体中显示了适度的生存率和自身移植重复手术率.
- 婴儿期是一个关键因素,与罗斯手术后的明显较差的生存率和增加的再干预率有关.
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