LONG-TERM OUTCOME AFTER SURGICAL REPAIR OF ISOLATED ATRIAL SEPTAL-DEFECT - FOLLOW-UP AT 27 TO 32 YEARS
LONG-TERM OUTCOME AFTER SURGICAL REPAIR OF ISOLATED ATRIAL SEPTAL-DEFECT - FOLLOW-UP AT 27 TO 32 YEARS
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DOI：
10.1056/nejm199012133232401
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发表时间：
1990-12-13
影响因子：
158.5
通讯作者：
DANIELSON, GK
中科院分区：
文献类型：
--
作者：
MURPHY, JG;GERSH, BJ;DANIELSON, GK
背景：房间隔缺损的外科治疗已有30多年的历史。早期心脏手术患者的长期生存率记录不多，但这些数据对这些患者未来的医疗保健、就业能力和保险能力至关重要。方法：为了确定手术矫正房间隔缺损的自然史，我们研究了1956年至1960年期间在马约诊所接受孤立性缺损（分泌孔或静脉窦）修复术的所有123例患者，手术后27至32年。通过书面问卷和电话访谈确定所有患者的随访状态。如果发生中期住院或死亡，则获得医院记录和死亡证明。结果如下：围手术期幸存者的30年总生存率为74%，而年龄和性别匹配的对照组为85%。围手术期死亡率为3.3%（4例死亡）。根据手术时年龄，年轻两个四分位数患者的实际27年生存率（≤ 27岁）11岁和12至24岁）与对照组的比率没有差异-分别为97%和93%。在年龄较大的两个四分位数（25 - 41岁和> 41岁）中，27年生存率显著低于（P < 0.001）对照组（分别为84%和40%）（91%和59%）。多因素分析显示，手术年龄（P < 0.0001）和术前主肺动脉收缩压（P < 0.0027）是长期生存的独立预测因素。当对老年患者进行修复时，晚期心脏故障、中风和房颤的发生率明显更高。结论：在房间隔缺损手术修补的患者中，25岁以前手术的患者预后良好，但年龄较大的患者需要仔细、定期的监护。
Background: Atrial septal defects have been surgically correctable for more than 30 years. The long-term survival rates among patients treated in the early era of cardiac surgery are poorly documented, but such data are of critical importance to the future medical care, employability, and insurability of these patients. Methods: To determine the natural history of surgically corrected atrial septal defects, we studied all 123 patients who underwent repair of an isolated defect (ostium secundum or sinus venosus) at the Mayo Clinic between 1956 and 1960, 27 to 32 years after the procedure. The follow-up status of all patients was determined by written questionnaires and telephone interviews. Hospital records and death certificates were obtained if interim hospitalization or death had occurred. Results: The overall 30-year actuarial survival rate among survivors of the perioperative period was 74 percent, as compared with 85 percent among controls matched for age and sex. The perioperative mortality was 3.3 percent (four deaths). Acturial 27-year survival rates among patients in the younger two quartiles according to age at operation (.ltoreq. 11 years and 12 to 24 years) were no different from rates among controls-97 percent and 93 percent, respectively. In the two older quartiles (25 to 41 years and > 41 years), 27-year survival rates were significantly less (P < 0.001)-84 percent and 40 percent, respectively-than in controls (91 and 59 percent). Independent predictors of long-term survival according to multivariate analysis were age at operation (P < 0.0001) and systolic pressure in the main pulmonary artery before operation (P < 0.0027). When repair was performed in older patients, late cardiac faulure, stroke and atrial fibrillation were significantly more frequent. Conclusions: Among patients with surgically repaired atrial septal defects, those operated on before the age of 25 have an excellent prognosis, but older patients require careful, regular supervision.