Single-institution outcomes of surgical repair of infracardiac total anomalous pulmonary venous connection
Single-institution outcomes of surgical repair of infracardiac total anomalous pulmonary venous connection
复制标题
心下完全性肺静脉异位连接手术修复的单机构结果
DOI：
10.1016/j.jtcvs.2020.06.023
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发表时间：
2021-03-12
影响因子：
6
通讯作者：
Chen, Huiwen
中科院分区：
文献类型：
--
作者：
Shi, Guocheng;Zhu, Fang;Chen, Huiwen
目的：本当代研究旨在描述接受双心室修复术治疗心下型完全性肺静脉异位连接的患者的结局。方法：对2006年至2018年期间接受无缝线技术或传统修复术的心下型完全性肺静脉异位连接患者进行回顾性研究。采用考克斯回归模型分析术后肺静脉狭窄（PVS）和生存率的危险因素。使用Kaplan-Meier estimates.Results进行事件发生时间分析：本研究纳入了82例连续患者，中位年龄为21天（四分位距，9-40天）。中位随访时间为29个月（四分位距，12.5-59个月），在2019年研究期结束时，95%的幸存者可获得随访。总体而言，常规修复组发生8例死亡（8.5%）。传统修复组的死亡率有较高的趋势，尽管没有达到统计学差异（P = .2）。修复后PVS发生在术后中位2个月（四分位距，1.2-3.6个月），均发生在传统修复组。事件发生时间分析显示，无缝合技术组的再狭窄率显著更高（P = .0004）。时间依赖性考克斯模型校正的风险比描述了恢复后PVS与鹿角构型肺静脉汇合之间的相关性（风险比，2.14; 95%置信区间，1.03-5.47; P = .002）和使用无缝线技术结论：对于心下型完全性肺静脉异位引流患者，采用无缝线技术可降低术后PVS的风险。鹿角形肺静脉汇合构型与再狭窄和死亡率相关。
Objective: This contemporary study sought to describe the outcomes of patients undergoing biventricular repair of infracardiac total anomalous pulmonary venous connection.Methods: A retrospective study was performed on patients with infracardiac total anomalous pulmonary venous connection who underwent sutureless technique or conventional repair between 2006 and 2018. Risk factors for survival and post-repair pulmonary vein stenosis (PVS) were assessed with Cox regression model. Time-to-event analysis was conducted using Kaplan-Meier estimates.Results: This study included 82 consecutive patients with the median age of 21 days (interquartile range, 9-40 days). The median follow-up was 29 months (interquartile range, 12.5-59 months) and was available in 95% of the survivors at the end of the study period in 2019. Overall, 8 deaths (8.5%) occurred in the conventional repair group. There was a trend of higher mortality in the conventional repair group, although it did not reach a statistical difference (P = .2). Postrepair PVS occurred at a median of 2 months (interquartile range, 1.2-3.6 months) postoperatively and all occurred in the conventional repair group. Time-to-event analysis with the event of postrepair PVS showed significantly higher freedom from restenosis in the sutureless technique group (P = .0004). Adjusted hazard ratios from time-dependent Cox model described the association between postrepair PVS and pulmonary venous confluence of antler configuration (hazard ratio, 2.14; 95% confidence interval, 1.03-5.47; P = .002) and the use of sutureless technique (hazard ratio, 0.72; 95% confidence interval, 0.39-0.97; P = .003).Conclusions: Sutureless technique is associated with a lower risk of postrepair PVS in patients with infracardiac total anomalous pulmonary venous connection. pulmonary venous confluence configuration of antler appearance appears to be associated with restenosis and mortality.