Long-Term Results of Reoperation for Left Atrioventricular Valve Regurgitation After Correction of Atrioventricular Septal Defects
Long-Term Results of Reoperation for Left Atrioventricular Valve Regurgitation After Correction of Atrioventricular Septal Defects
复制标题
DOI：
10.1016/j.athoracsur.2011.09.043
复制
发表时间：
2012-03-01
影响因子：
4.6
通讯作者：
Hazekamp, Mark G.
中科院分区：
文献类型：
--
作者：
Hoohenkerk, Gerard J. F.;Bruggemans, Eline F.;Hazekamp, Mark G.
背景。先前矫正房室间隔缺损 (AVSD) 后左房室瓣关闭不全 (LAVVR) 再次手术的长期结果很少。我们评估了 LAVVR 再次手术的长期结果，并确定了再次手术的风险因素。方法。 1976年12月至2006年7月期间，312名矫正不同AVSD的患者中有45名接受了LAVVR再次手术。由 267 名不需要 LAVVR 再次手术的患者组成的队列可以识别再手术的风险因素，并在竞争风险情况下评估初次 AVSD 修复后的总体生存率。临床数据通过回顾性审查获得。结果。 31 名患者（68.9%）修复了左房室瓣（LAVV），14 名患者（31.1%）进行了置换。院内死亡 3 例（6.7%），晚期死亡 2 例（4.4%）。再手术后 15 年的估计总生存率为 88.1%，在初次 AVSD 修复后 15 年，整个患者队列中再手术后的估计死亡发生率为 2%。 LAVV 修复后的总生存率显着高于替换后 (p = 0.010)。 10 名接受 LAVV 修复的患者需要进行第二次 LAVVR 再次手术。随访时，幸存者处于纽约心脏协会功能分级 I (n = 36) 或 II (n = 4)。 LAVVR 首次再次手术的独立危险因素是相关心血管异常 (p < 0.001)、LAVV 发育不良 (p < 0.001) 和裂口未闭合 (p = 0.027)。结论。先前矫正 AVSD 后，LAVVR 通常可以通过瓣膜修复来矫正。严重发育不良的瓣膜可能需要更换。修复后的总体生存率高于更换后的总体生存率。一般来说，接受 LAVVR 再次手术的患者的总体生存率是有利的。 AVSD 初次修复后的总体死亡率只有一小部分可以用 LAVVR 再次手术后的死亡率来解释。 （Ann Thorac Surg 2012；93：849-55）（C）2012 年，胸外科医师协会
Background. Long-term results of reoperation for left atrioventricular valve regurgitation (LAVVR) after previous correction of atrioventricular septal defect (AVSD) are scarce. We evaluated long-term outcome of reoperation for LAVVR and identified risk factors for reoperation.Methods. Between December 1976 and July 2006, 45 of 312 patients with correction of different AVSDs underwent reoperation for LAVVR. The cohort of 267 patients who did not need reoperation for LAVVR allowed for the identification of risk factors for reoperation and evaluation of overall survival after primary AVSD repair in a competing risk scenario. Clinical data were obtained by retrospective review.Results. The left atrioventricular valve (LAVV) was repaired in 31 patients (68.9%) and replaced in 14 (31.1%). There were 3 in-hospital deaths (6.7%) and 2 late deaths (4.4%). Estimated overall survival was 88.1% at 15 years after the reoperation, and estimated incidence of death after reoperation in the total patient cohort was 2% at 15 years after the primary AVSD repair. Overall survival was significantly higher after LAVV repair than after replacement (p = 0.010). Ten patients with LAVV repair required a second reoperation for LAVVR. At follow-up, survivors were in New York Heart Association functional class I (n = 36) or II (n = 4). Independent risk factors for first reoperation for LAVVR were associated cardiovascular anomalies (p < 0.001), LAVV dysplasia (p < 0.001), and nonclosure of the cleft (p = 0.027).Conclusions. After previous correction of AVSD, LAVVR can usually be corrected by valve repair. A very dysplastic valve may necessitate replacement. Overall survival is higher after repair than after replacement. In general, overall survival of patients reoperated on for LAVVR is favorable. The overall mortality rate after primary repair of AVSD is explained only for a small part by mortality after reoperation for LAVVR. (Ann Thorac Surg 2012; 93: 849-55) (C) 2012 by The Society of Thoracic Surgeons