COARCTATION OF THE AORTA - LONG-TERM FOLLOW-UP AND PREDICTION OF OUTCOME AFTER SURGICAL-CORRECTION
COARCTATION OF THE AORTA - LONG-TERM FOLLOW-UP AND PREDICTION OF OUTCOME AFTER SURGICAL-CORRECTION
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DOI：
10.1161/01.cir.80.4.840
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发表时间：
1989-10-01
期刊：
影响因子：
37.8
通讯作者：
MCGOON, DC
中科院分区：
文献类型：
--
作者：
COHEN, M;FUSTER, V;MCGOON, DC
长期的临床过程进行了研究，在646例患者中，谁进行了隔离手术修复主动脉缩窄在马约诊所从1946年至1981年。有17例围手术期死亡，58例患者失访。在长期随访的571例患者中，11%需要随后的心血管手术，25%发生高血压。有87人死亡。死亡时的平均年龄为38岁（范围，0-67岁）。估计生存率分析显示，手术修复后10年时91%的患者存活，20年时84%的患者存活，30年时72%的患者存活。晚期死亡的最常见原因是32例患者的冠状动脉疾病，其次是猝死、心力衰竭、脑血管意外和主动脉瘤破裂。年龄、性别和术后收缩压是生存率的独立预测因素。对于初次手术时年龄小于14岁的患者，20年生存率为91%，对于手术时年龄大于或等于14岁的患者，20年生存率为79%。术后收缩压越高，死亡率越高。本研究中接受主动脉缩窄修复术的人群最多，中位随访时间长达20年。出现了四个要点。1)初次修复时的年龄是长期生存的最重要预测因素。如果高血压严重，应在1岁或1岁以下的患者进行手术。2)冠状动脉疾病是最常见的死亡原因。3)初次修复时的年龄是高血压最重要的预测因素。4)需要后续手术的相关心血管异常很常见。因此，所有患者在主动脉缩窄修补术后都需要持续长期监测。
The long-term clinical course was studied in 646 patients, who underwent isolated operative repair of coarctation of the aorta at the Mayo Clinic from 1946 to 1981. There were 17 perioperative deaths, and 58 patients were lost to follow-up. Of the 571 patients with long-term follow-up, 11% required subsequent cardiovascular surgery, and 25% developed hypertension. There were 87 late deaths. The mean age at death was 38 years (range, 0-67 years). Estimated survival analysis revealed 91% of patients alive at 10, 84% at 20, and 72% at 30 years after operative repair. The most common cause of late death was coronary disease in 32 patients, followed by sudden death, heart failure, cerebrovascular accidents, and ruptured aortic aneurysm. Age, sex, and postoperative systolic blood presure were found to be independently predictive of survival. For patients less than 14 years of age at the time of initial coarctectomy, survival to 20 years was 91%, and for patients 14 years or older at the time of operation, survival was 79%. The best survivorship was observed in patients operated on at 9 years of ag or less. The higher the postoperative systolic pressure, the higher the probability of death. This study has the largest population undergoing repair of coarctation of the aorta with a medium follow-up of as long as 20 years. Four main points emerged. 1) Age at the time of initial repair is the most important predictor of long-term survival. Surgery should be offered to patients after age 1 year or sooner if hypertension is severe. 2) Coronary artery disease is the most common cause of death. 3) Age at the time of initial repair is the most important predictor of hypertension. 4) Associated cardiovascular anomalies requiring subsequent surgery are common. Therefore, all patients need continuous long-term monitoring after repair of coarctation of the aorta.