儿童主动脉缩窄术后再缩窄内外科治疗的单中心回顾性分析

Outcomes of arch reintervention for post-repair recoarctation:A retrospectivel analysis in a single center

目的探讨儿童主动脉缩窄术后再缩窄的内外科再干预结果。方法2009—2019年上海儿童医学中心共收治48例主动脉术后再缩窄患者,男35例、女13例。其中,外科补片修补22例,内科球囊扩张25例,内科支架置入1例。回顾性分析患儿再干预前资料、再干预过程以及随访资料。外科补片修补与球囊扩张的再干预后残余缩窄或再缩窄情况通过log-rank检验进行比较。结果中位再干预年龄为15.0个月(3.0个月至15.1岁);中位再干预体重为9.8(3.0~58.0)kg。再干预时与初次手术的中位时间间隔为12.5个月(2.0个月至7.8年)。手术再干预后出现1例(2.1%)院内死亡、1例(2.1%)心律失常以及1例(2.1%)远期死亡。球囊扩张后出现1例(2.1%)局限性夹层,无早远期死亡发生。再干预后1年、2年、5年免于残余缩窄或再缩窄的概率总体为66.7%、61.3%、56.9%,手术组为90.0%、81.8%、70.1%,球囊扩张组为52.0%、48.0%、48.0%。手术组再干预后残余缩窄或再缩窄的概率显著低于球囊扩张组(χ^(2)=4.400,P=0.036)。结论主动脉再缩窄的内外科治疗均较为安全且早期效果满意。再干预后残余缩窄或再缩窄不少见,与内科球囊扩张相比,外科手术解除梗阻更有效且更持久。

Objective To discuss outcomes of arch reintervention for post-repair recoarctation in children.Methods From 2009 to 2019,48 patients underwent reintervention for post-repair recoarctation in Shanghai Children’s Medical Center.Of the 48 patients,22 patients had surgical repair,25 patients had balloon angioplasty(BA),and 1patient had a stent implantation.The clinical data were analyzed,and the difference in time-to-event distribution between the surgical group and the BA group was determined by a log-rank test.Results The median age at reintervention was 15.0 months(range,3.0 months-15.1 years).The median weight at reintervention was 9.8 kg(range,3.0-58.0 kg).The time to reintervention after initial repair was 12.5 months(range,2.0 months-7.8 years).One patient(2.1%)died in hospital and 1 patient(2.1%)experienced arrhythmia after surgical repair.One late mortality(2.1%)occurred after surgical reintervention.One patient(2.1%)experienced aortic dissection after BA.No patient died after BA.Freedom from residual coarctation or new recurrences was 66.7%,61.3%,and 56.9%,respectively,at 1,2,and 5 years after reintervention.Freedom from residual coarctation or new recurrences was 90.0%,81.8%,and 70.1%,respectively,at 1,2,and 5 years after surgical repair.Freedom from residual coarctation or new recurrences was 52.0%,48.0%,and 48.0%,respectively,at 1,2,and 5 years after BA.Compared with BA,surgery-based reintervention had a lower incidence of residual coarctation or recurrences(χ^(2)=4.400,P=0.036).Conclusion Reintervention for recoarctation has favorable early outcomes.Compared with balloon angioplasty,surgical repair has a more lasting effect in relieving the recoarctation.