Repair of atrioventricular septal defect associated with tetralogy of Fallot or double-outlet right ventricle: 30 years of experience.
Repair of atrioventricular septal defect associated with tetralogy of Fallot or double-outlet right ventricle: 30 years of experience.
复制标题
修复与法洛四联症或右心室双出口相关的房室间隔缺损：30 年经验。
DOI：
10.1016/j.athoracsur.2012.02.070
复制
发表时间：
2012
期刊：
影响因子：
--
通讯作者：
I. Konstantinov
中科院分区：
文献类型：
--
作者：
Jeremy Ong;C. Brizard;Y. D'udekem;R. Weintraub;Terry Robertson;M. Cheung;I. Konstantinov
背景近年来，房室间隔缺损（AVSD）合并法洛四联症（TOF）或右心室双出口（DORV）的外科治疗效果有所改善。然而，仍有高死亡率和再手术率的报道。本研究回顾了我们在完全性AVSD和TOF或DORV患者中的手术经验。方法1980年至2010年，48例连续AVSD合并TOF（n = 26）或DORV（n = 22）患者接受了完全修复;其中19例进行了分期修复。采用双补片技术的经心房-经硬膜入路是首选手术技术。资料来源于住院病人和门诊病人的医疗档案。死亡率为8.3%（4/48）的住院死亡和13.6%（6/44）的晚期死亡。平均随访时间为8.0 ± 8.7年（中位数10.8年;范围为2个月至30年）。5年生存率为76%，20年生存率为71%。2001年以后没有发生死亡事件。48例患者中有16例（33%）需要再次手术。5年和20年时的总体无再次手术率为55%。Down综合征对再次手术有保护作用（p = 0.022）。分离上级桥接瓣叶提供了极好的暴露。然而，再手术率仍然很高。
BACKGROUNDThe surgical outcomes of atrioventricular septal defect (AVSD) associated with tetralogy of Fallot (TOF) or double-outlet right ventricle (DORV) have improved in recent times. However, high mortality and reoperation rates are still reported. This study reviews our surgical experience in patients with complete AVSD and TOF or DORV.METHODSBetween 1980 and 2010, 48 consecutive patients with AVSD associated with TOF (n = 26) or DORV (n = 22) underwent complete repair; of which, 19 had staged repair. A transatrial-transpulmonary approach with the 2-patch technique was the preferred surgical technique. Data were obtained from inpatient and outpatient medical files.RESULTSThe mortality rates were 8.3% (4 of 48) for in-hospital death and 13.6% (6 of 44) for late death. Mean follow-up was 8.0 ± 8.7 years (median 10.8 years; range from 2 months to 30 years). Actuarial survival was 76% at 5 years and 71% at 20 years. No deaths occurred after 2001. Reoperations were required in 16 of 48 patients (33%). The overall freedom from reoperation was 55% at 5 and 20 years. Down syndrome was protective for reoperation (p = 0.022).CONCLUSIONSComplete AVSD associated with TOF or DORV can be repaired with good survival. Detachment of the superior bridging leaflet provided excellent exposure. However, reoperation rate remains high.