Long-Term Results of Bilateral Pulmonary Artery Banding Versus Primary Norwood Procedure.
Long-Term Results of Bilateral Pulmonary Artery Banding Versus Primary Norwood Procedure.
复制标题
双侧肺动脉束带术与初次诺伍德手术的长期结果。
DOI：
10.1007/s00246-017-1735-1
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发表时间：
2018
期刊：
影响因子：
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通讯作者：
Takamoto S.
中科院分区：
文献类型：
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作者：
Hirata Y;Miyata H;Hirahara N;Murakami A;Kado H;Sakamoto K;Sano S;Takamoto S.
双侧肺动脉环扎术（PAB）已成为治疗左心发育不良综合征（HLHS）的一种有吸引力的初始治疗方法，一些中心报告了极好的生存率。然而，它的使用是可变的机构之间，其真正的功效是未知的，由于报告的偏见。我们的目的是使用国家数据库描述双侧PAB使用的结果、术前风险因素和与初次诺伍德手术相比的长期结局。纳入了日本先天性心血管手术数据库（JCCVSD）中列出的2008年1月至2012年12月期间接受双侧PAB或诺伍德手术作为HLHS初始缓解的婴儿。被诊断患有HLHS的患者总数为334例。256例患者行双侧PAB，78例患者行初次诺伍德手术作为初始手术。5年生存率为59.0%。初次诺伍德手术组的5年生存率[75.5%; 95%置信区间（CI）63.2-84.1]优于双侧PAB组（75.5 vs. 54.0%，对数秩和检验p < 0.001）。然而，双侧PAB组有更显著的风险因素。当对风险调整后的结局进行评价时，在高容量机构中，初次诺伍德组和双侧PAB组之间无显著差异（76.4 vs. 78.1%，对数秩和检验p = 0.87）。原发性诺伍德组的5年生存率高于双侧PAB组，但双侧PAB组的术前风险较高。由于在HLHS容量较高的机构进行时，结果相当，因此适当的患者选择对于实现良好的长期结果至关重要。
Bilateral pulmonary artery banding (PAB) has emerged to be an attractive option as an initial procedure for the treatment of hypoplastic left heart syndrome (HLHS), and some centers report excellent survival. However, its usage is variable among institutions and its true efficacy is unknown due to reporting biases. We aimed to describe the results of bilateral PAB use, preoperative risk factors, and long-term outcomes compared with primary Norwood procedure, using a national database. Infants who underwent bilateral PAB or Norwood procedure as an initial palliation for HLHS between January 2008 and December 2012 listed in the Japan Congenital Cardiovascular Surgery Database (JCCVSD) were included. The total number of patients diagnosed with HLHS was 334. Bilateral PABs were performed for 256 patients and primary Norwood procedures for 78 patients, as an initial procedure. Actuarial 5-year survival was 59.0%. The primary Norwood procedure group had better 5-year survival [75.5%; 95% confidence interval (CI) 63.2–84.1] than the bilateral PAB group (75.5 vs. 54.0%, log-rankp< 0.001). However, the bilateral PAB group had more significant risk factors. When the risk-adjusted outcomes were evaluated, there was no significant difference between the primary Norwood group and the bilateral PAB group (76.4 vs. 78.1%, log-rankp= 0.87) in higher volume institutions. The primary Norwood group had better 5-year survival than the bilateral PAB group, but preoperative risk was higher in the bilateral PAB group. Because outcomes are comparable when performed at higher HLHS volume institutions, proper patient selection is important in achieving good long-term result.