改良单片法治疗完全性房室间隔缺损术后死亡与再手术结果:单中心经验

Mortality and reoperation outcomes after repair of complete atrioventricular septal defect with a modified single-patch technique:a single-center experience

目的确定影响完全性房室间隔缺损行改良单片法术后死亡与再手术的危险因素,并评价改良单片法手术中、远期预后。方法选取2008年3月至2022年3月于南京市儿童医院心胸外科接受完全性房室间隔缺损矫治术后的患儿,共266例。排除法洛四联征、大动脉转位、右心室双出口等圆锥动脉干异常者。分析其人口统计学特征、手术数据、术后随访以及相关风险因素。结果所有患儿首次矫治术均采用改良单片法,26例患儿因严重的左侧房室瓣反流、左心室流出道梗阻、房室传导阻滞等原因再次手术。所有患儿1年、3年、5年总体生存率和免于再手术率分别为(98.1±0.8)%、(97.3±1.0)%、(96.2±1.2)%,(96.6±1.1)%、(93.9±1.5)%、(92.2±1.7)%。术后早期再手术11例(42.3%),晚期再手术者15例(57.7%),其1年、3年、5年生存率分别为(92.3±5.2)%,(82.1±8.3)%,(76.6±9.4)%。通过多因素分析显示年龄<3个月和术后24h左侧房室瓣反流>2级是导致再手术的独立危险因素,而年龄<3个月和有再手术经历是导致患儿死亡的独立危险因素。结论目前完全性房室间隔缺损有着很好的外科疗效,但仍有部分患儿需要再次手术,年龄<3个月、术后左侧房室瓣反流>2级仍然是影响其手术预后的重要预测因素。

Objective To determine the risk factors of reoperation and mortality after complete atrioventricular septal de-fect repair,and to evaluate the medium and long-term prognosis.Methods From March 2008 to March 2022,a total of 266 children were selected from the Department of Thoracic and Cardiovascular Surgery,Nanjing Children's Hospital,who under-went the complete atrioventricular septal defect repair.Exclusion of children with conotrucal anomaly such as tetralogy of Fal lot,transposition of the great arteries,and right ventricular double outlet.Demographic characteristics,surgical data,postoper-ative follow-up and associated risk factors were analyzed.ResultsAll the children were repaired with modified single-piece method for thefirst time,and 26 children were reoperated because of severe left atrioventricular valve regurgitation,left ventric ular outflow tract obstruction and atrioventricular block.The 1-year,3-year and 5-year overall survival rate and freedom from reoperation rate of all children were(98.1±0.8)%,(97.3±1.0)%,(96.2±1.2)%,(96.6±1.1)%,(93.9±1.5)%and(92.2±1.7)%,respectively.A total of 11(42.3%)early reoperations and 15(57.7%)late reoperations were performed,of which 1-year,3-year and 5-year survival rates were(92.3±5.2)%,(82.1±8.3)%and(76.6±9.4)%respectively.Multifactorial analysis showed that age<3 months and left atrioventricular regurgitation>grade 2 at 24 hours postoperatively were independent risk factors for reoperation,whereas age<3 months and experience of reoperation were independent risk factors for death of children.Conclusion Complete atrial septal defects have excellent surgical outcomes,but some children still require reoperation,and age<3 months and postoperative left atrioventricular valve regurgitation(LAVVR)>2 grades remain important predictors of their surgical prognosis.