房室间隔缺损矫治术后再次干预的回顾性分析

Retrospective for reoperation after primary atrioventricular septal defect repair

目的:回顾性分析房室间隔缺损(AVSD)矫治术后再次干预的特点与临床转归。方法:收集2005年至2019年间,在我院实施AVSD术后再次干预的病例,分为完全型和部分型组,分析两组患者术前基本资料和手术资料,观察术后早期结果和随访转归情况。结果:全组45例,完全型房室间隔缺损(CAVSD)18例(40%),部分型房室间隔缺损(PAVSD)27例(60%)。再次干预时完全型组的年龄和体质量均低于部分型组(P<0.05)。全组死亡共3例,均为完全型组,(P<0.05)。随访1、5和10年,完全型组的生存率分别为86.7%、77%和77%;部分型组未发生第3次等多次手术的风险分别为95%、95%和76%。结论:左侧房室瓣反流仍是AVSD再次手术的主要原因,左心室流出道狭窄需要给予关注,CAVSD再次干预的死亡率高于部分型,而PAVSD再次干预后远期多次手术发生率高于CAVSD。

Objective:This study is a retrospective analysis that the characteristics and clinical outcome of the patients with atrioventricular septal defect(AVSD)who underwent re-intervention in our center.Methods:All consecutive patients with repaired AVSD who underwent redo-operation from 2005 to 2019 were included.Patients were divided into complete and partial type groups.We analyzed the preoperative and operative data of the two groups,and observed the early result and follow-up result.Results:There were a total of 45 patients including 18 complete AVSD(CAVSD)(40%)and 27 partial AVSD(PAVSD)(60%).The mean body weight was 35 kg(16~59.1 kg).There were 18(40%)patients with complete AVSD and 27(60%).The age and weight of the complete group were lower than that of the partial group at the time of re-intervention with PAVSD(P<0.05).There were 3 death in the whole group,they were complete type group(P<0.05).The survival rate of CAVSD was 86.7%,77%and 77%at 1 years,5 years and 10 years.The freedom not further reoperation of PAVSD was 95%,95%and 76%at1 year,5 years and 10 years.Conclusions:The postoperative left atrio-ventricular valve(LAVV)regurgitation is the main reason of the reoperation.Left ventricle outflow tract obstruction(LVOTO)needs the attention of surgeons.The mortality of CAVSD is higher than PAVSD,The re-intervention rate of PAVSD is higher than CAVSD.