Primary Pulmonary Vein Stenosis: Outcomes, Risk Factors, and Severity Score in a Multicentric Study
Primary Pulmonary Vein Stenosis: Outcomes, Risk Factors, and Severity Score in a Multicentric Study
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DOI：
10.1016/j.athoracsur.2017.03.022
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发表时间：
2017-07-01
影响因子：
4.6
通讯作者：
Lacour-Gayet, Francois
中科院分区：
文献类型：
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作者：
Kalfa, David;Belli, Emre;Lacour-Gayet, Francois
背景资料。原发性肺静脉狭窄(PPVs)的预后仍然很差，其预后因素仍存在争议。这项研究的目的是确定当今时代PPV修复后的结果和预后因素。对2000-2012年在10个欧洲/北美中心进行的30例肺静脉(PV)连接正常的PPV患者进行了回顾性研究。根据对每个PV的评估，制定了特定的PVS严重程度评分。研究终点为死亡、肺静脉再手术和再狭窄。进行单因素和多因素风险分析。平均每个患者受影响的静脉数量为2.7+/-1.1个。无缝合修补术21例(70%)，腔内静脉切除术5例，补片静脉成形术4例。总的门静脉再狭窄、再手术和死亡率分别为50%、40%和30%。随访8年，无死亡、无再手术和无再狭窄发生率分别为70%±8%、62%±8%和47%±9%。再狭窄发生率和死亡率分别为57%(12/21)和38%(8/21)，死亡率分别为33%(3/9)和11%(1/9)(P=0.21)。选择无缝合技术的患者在手术前更年轻、更小，并且有更严重的疾病。术后1个月PVS评分高和肺动脉高压是再狭窄的独立危险因素(危险比分别为1.3 4和6.81，P=0.0 2)、再手术(HR，1.2 4；P=0.0 1和HR 7.6 0；P=0.0 2)和死亡率(HR，1.3 9；P=0.0 1和HR 39.5，P=0.008)。尽管采用了无缝合技术，但在当今时代，原发PVS的预后仍然是谨慎的。术后肺动脉高压和病情严重程度是独立的预后因素，与手术方法无关。(C)2017年，由胸外科医生学会主办
Background. Primary pulmonary vein stenosis (PPVS) still carries a poor prognosis, and prognostic factors remain controversial. The aim of this study was to determine outcomes and prognostic factors after PPVS repair in the current era.Methods. Thirty patients with PPVS and a normal pulmonary vein (PV) connection operated on in 10 European/North American centers (2000-2012) were included retrospectively. A specific PVS severity score was developed based on the assessment of each PV. Studied end points were death, PV reoperation, and restenosis. A univariate and multivariate risk analysis was performed.Results. The mean number of affected PVs per patient was 2.7 +/- 1.1. Sutureless repair was used in 21 patients (70%), endovenectomy was used in 5 patients, and patch venoplasty was used in 4 patients. Overall PV restenosis, reoperation, and mortality occurred in 50%, 40%, and 30% of patients respectively. Freedom from mortality, reoperation, and restenosis at 8 years of follow-up was 70% +/- 8%, 62% +/- 8%, and 47% +/- 9%, respectively. Restenosis and mortality rates after sutureless repair versus non-sutureless repair were 57% (n = 12 of 21) versus 33% (n[ 3 of 9) (p = 0.42) for restenosis and 38% (n = 8 of 21) versus 11% (n = 1 of 9) (p = 0.21) for mortality. Patients selected for a sutureless technique were younger and smaller and had more severe disease before operation. A postoperative high PVS score and pulmonary hypertension 1 month after the operation were independent risk factors for restenosis (hazard ratio [HR], 1.34; p = 0.002 and HR, 6.81; p = 0.02, respectively), reoperation (HR, 1.24; p = 0.01 and HR, 7.60; p = 0.02), and mortality (HR, 1.39; p = 0.01 and HR, 39.5; p = 0.008).Conclusions. Primary PVS still has a guarded prognosis in the current era despite adoption of the sutureless technique. Postoperative pulmonary hypertension and severity of disease evaluated by a new severity score are independent prognostic factors regardless of surgical technique. (C) 2017 by The Society of Thoracic Surgeons