Intraoperative Echocardiography for Congenital Aortic Valve Repair: Predictors of Early Reoperation.
Intraoperative Echocardiography for Congenital Aortic Valve Repair: Predictors of Early Reoperation.
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先天性主动脉瓣修复术中超声心动图：早期再手术的预测因素。
DOI：
10.1016/j.athoracsur.2015.05.002
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发表时间：
2015
期刊：
影响因子：
--
通讯作者：
Geva,Tal
中科院分区：
文献类型：
--
作者：
Stern,KenanWD;White,MatthewT;Verghese,GeorgeR;DelNido,PedroJ;Geva,Tal
背景：我们试图确定经食管超声心动图（TEE）预测先天性主动脉瓣疾病患者体外循环（CPB）后复发性主动脉反流（AR）早期再手术的预测因素。方法分析先天性主动脉瓣病变行主要AR修复的患者cpb后tee，其中2年内再次手术治疗复发性AR，对照组3年以上无再次手术。结果病例患者（n = 22，中位再手术时间0.3年）与对照患者（n = 22，中位再手术自由时间≥4.4年）在人口学特征、主动脉尺寸和术前AR分级方面相似。在cpb后TEE变量中，单变量logistic回归分析发现，覆盖高度缩短（1毫米的优势比[OR]增加0.72,95%可信区间[CI]: 0.54至0.95,p= 0.02），覆盖高度与环径之比降低（OR为5%，减少1.37,95% CI: 1.06至1.77,p= 0.02），短轴视图中最长和最短覆盖长度之间的百分比差异(OR为10%，增加1.84,95% CI: 1.15至2.92；p= 0.01)是复发性AR早期再手术的危险因素。多变量分析发现，短轴适应长度的%差异是cpb后TEE最强的预测因子（受试者操作曲线下面积= 0.743）。50% diff的敏感性和特异性分别为0.45和0.91,30% diff的敏感性和特异性分别为0.75和0.67。结论配位不对称与先天性瓣膜修复术后复发性AR的早期再手术有关，以cpb后TEE短轴配位长度差异增加%来衡量。
BackgroundWe sought to identify transesophageal echocardiography (TEE) predictors of early reoperation for recurrent aortic regurgitation (AR) after cardiopulmonary bypass (CPB) in patients undergoing repair for congenital aortic valve disease.MethodsWe analyzed post-CPB TEEs in patients with congenital aortic valve disease undergoing repair for predominant AR. Case patients underwent reoperation for recurrent AR within 2 years, whereas control patients were free from reoperation for more than 3 years.ResultsCase patients (n = 22; median time to reoperation 0.3 years) and control patients (n = 22; median freedom from reoperation ≥4.4 years) were similar for demographic characteristics, aortic dimensions, and preoperative AR grade. Among post-CPB TEE variables, univariate logistic regression analysis identified shorter coaptation height (odds ratio [OR] for 1-mm increase 0.72, 95% confidence interval [CI]: 0.54 to 0.95;p= 0.02), decreased ratio of coaptation height to annulus diameter (OR for a 5% decrease 1.37, 95% CI: 1.06 to 1.77;p= 0.02), and increased percentage difference (%diff) between longest and shortest coaptation lengths in a short-axis view (OR for 10% increase 1.84, 95% CI: 1.15 to 2.92;p= 0.01) as risk factors for early reoperation for recurrent AR. Multivariable analysis identified %diff in short-axis coaptation lengths as the strongest post-CPB TEE predictor (area under receiver operator curve = 0.743). The sensitivity and specificity of a %diff of 50% were 0.45 and 0.91, whereas a %diff of 30% had a sensitivity of 0.75 and specificity of 0.67.ConclusionsCoaptation asymmetry, measured as increased %diff in short-axis coaptation lengths on post-CPB TEE, is associated with early reoperation for recurrent AR after congenital valve repair.
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