Superior Approach for Supracardiac Total Anomalous Pulmonary Venous Connection
Superior Approach for Supracardiac Total Anomalous Pulmonary Venous Connection
复制标题
心上完全异常肺静脉连接的优质方法
DOI：
10.1016/j.athoracsur.2018.01.039
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发表时间：
2018
影响因子：
4.6
通讯作者：
Chen Huiwen
中科院分区：
文献类型：
--
作者：
Rong Liufu;Shi Guocheng;Zhu Fang;Guan Yongmei;Lu Zhaohui;Chen Weimin;Zhu Zhongqun;Chen Huiwen
背景经上入路修复心上全异常肺静脉连接的手术效果研究并不多见。方法2004年1月~ 2016年1月对198例心上全异肺静脉连接患者行上入路肺静脉与左心房侧对侧吻合。Kaplan-Meier曲线用于证明生存估计。采用Cox比例风险模型和竞争风险回归模型确定死亡和术后肺静脉梗阻的危险因素。结果住院死亡6例，无晚期死亡病例。30天、1年、12年生存率分别为97%、97%、97%。92.2%的幸存者完成了随访。中位随访时间为47个月（范围：0 ~ 136个月）。27例（14.1%，192例中的27例）因肺静脉阻塞、残留房间隔缺损或上腔静脉综合征需要再次手术。多因素分析显示，术前肺静脉阻塞（p= 0.012）、较长通气时间（p= 0.011）和紧急手术（p= 0.010）是增加的死亡危险因素。主动脉交叉夹持时间（p< 0.001）和术前肺静脉阻塞（p= 0.002）与术后肺静脉阻塞相关。结论经上入路侧对侧吻合修复心上全异肺静脉连接可取得满意的效果。
BackgroundStudies on the outcomes of surgical repair for supracardiac total anomalous pulmonary venous connection through the superior approach are uncommon.MethodsFrom January 2004 to January 2016, 198 patients with supracardiac total anomalous pulmonary venous connection underwent side-to-side anastomosis between the common pulmonary vein and left atrium through the superior approach. Kaplan-Meier curve was used to demonstrate the survival estimates. Cox proportional hazard model and competing risk regression model were used to identify risk factors for death and postoperative pulmonary venous obstruction.ResultsThere were six in-hospital deaths and no late deaths. The survival rates at 30 days, 1 year, and 12 years were 97%, 97%, and 97%, respectively. Follow-up was completed in 92.2% of the survivors. Median follow-up was 47 months (range: 0 to 136 months). Twenty-seven patients (14.1%, 27 of 192) required reoperation for pulmonary venous obstruction, residual atrial septal defect, or superior cava vena syndrome. Multivariable analysis showed that preoperative pulmonary venous obstruction (p= 0.012), longer duration of ventilation (p= 0.011), and emergency operation (p= 0.010) were incremental risk factors for death. Aortic cross-clamp time (p< 0.001) and preoperative pulmonary venous obstruction (p= 0.002) were associated with postoperative pulmonary venous obstruction.ConclusionsSide-to-side anastomosis through a superior approach in surgical repair of supracardiac total anomalous pulmonary venous connection can achieve satisfactory results.