经皮球囊主动脉瓣成形术治疗儿童先天性主动脉瓣狭窄远期预后观察  

Long-term outcome of percutaneous balloon aortic valvuloplasty for children with congenital aortic valve stenosis

作　　者：韩咏 李俊杰 张智伟[2] 钱明阳[2] 王树水[2] Han Yong;Li Junjie;Zhang Zhiwei;Qian Mingyang;Wang Shushui(Department of Peadatric Cardiology,Liuzhou Maternal and Child Health Hospital,Liuzhou 545001,China;Department of Peadatric Cardiology,Guangdong Academy of Medical Sciences,Guangdong Provincial People′s Hospital,Guangdong Cardiovascular Institute,Guangzhou 510100,China)

机构地区：[1]柳州市妇幼保健院儿内科,545001 [2]广东省医学科学院,广东省人民医院心儿科,广东省心血管病研究所,广州510100

出　　处：《中华心血管病杂志》2020年第10期853-858,共6页Chinese Journal of Cardiology

基　　金：国家重点研发计划(2016YFC1100300)。

摘　　要：目的:评估经皮球囊主动脉瓣成形术(PBAV)治疗儿童先天性主动脉瓣狭窄(CAS)的疗效及远期预后,初步探讨术后明显的主动脉瓣反流(AR)及再干预的危险因素。方法:该研究为回顾性研究。入选2004年1月至2018年12月在广东省人民医院心儿科接受PBAV术的CAS患儿(年龄≤18岁)。收集纳入患儿的人口学、术前经胸超声心动图(TTE)检查及PBAV手术资料。术后密切观察患儿的并发症发生情况,于术后1、6、12个月及此后每隔1年对患儿进行随访,终点事件包括明显的AR和再干预。其中,再干预定义为因各种原因需对瓣膜进行任何一种干预,包括再次PBAV、外科瓣膜成形术和瓣膜置换术;明显的AR定义为TTE测得AR≥3级。收集研究结束前的最后一次TTE检查结果。绘制纳入患儿的远期无明显的AR和无再干预生存率的Kaplan-Meier曲线,并采用Cox回归模型进一步分析CAS患儿PBAV术后明显的AR和再干预的危险因素。结果:研究最终纳入55例CAS患儿,年龄4.6(1.6,6.5)岁,男童37例(67.3%)。术后即刻跨主动脉瓣压力阶差低于术前[(38.5±18.5)mmHg(1 mmHg=0.133 kPa)比(80.3±30.6)mmHg, P<0.001]。手术成功率为89%(49/55)。18例患儿术后即刻出现AR,其中AR≥3级者3例。6例患儿于院内出现并发症(死亡2例、一过性心律失常2例、股动脉栓塞2例)。最终50例完成远期随访,随访时间为6.2(3.4,8.5)年。随访期间20例患儿发生明显的AR,术后5年和10年无明显的AR生存率分别为53%和19%。11例患儿接受再干预(瓣膜成形术4例,瓣膜置换术7例),术后5年和10年无再干预生存率分别为87%和62%。多因素Cox回归分析显示术后即刻AR( HR=2.398,95% CI 1.007~5.712, P=0.048)是远期明显的AR的危险因素;术后残余压力阶差≥35 mmHg( HR=4.747,95% CI 1.116~19.329, P=0.030)和术后即刻AR( HR=5.104,95% CI 1.083~24.065, P=0.039)是远期再干预的危险因素。 结论:PBAV治疗儿童CAS安全、有效,但需留意远期明�Objective To assess the efficacy and long-term outcome of percutaneous balloon aortic valvuloplasty(PBAV)for children with congenital aortic stenosis(CAS)and to explore risk factors for significant aortic regurgitation(AR)and reintervention after PBAV during follow up.Methods This was a retrospective study.Children(≤18 years old)with CAS,who underwent PBAV in Guangdong Provincial Hospital from January 2004 to December 2018,were included in this study.Demographic,preoperative transthoracic echocardiography(TTE)and surgical data were collected.Postoperative complications were closely observed,and the patients were followed up at 1,6,12 months after the operation,and then at one year interval thereafter.Endpoint events included significant AR and reintervention.Reintervention was defined as any intervention that needed to be performed on the valve for various reasons,including re-PBAV,surgical valvuloplasty and valve replacement.Significant AR was defined as AR grade≥3 by TTE criteria.The results of the last TTE examination before the end of the study were collected.The Kaplan-Meier curve for long-term AR-free and intervention-free survival was plotted.Cox regression model was used to further analyze the risk factors for significant AR and reintervention after PBAV in CAS patients.Results A total of 55 patients were enrolled in this study,and the age was 4.6(1.6,6.5)years,with 37(67.3%)males.The peak systolic valve gradient fell from(80.3±30.6)mmHg to(38.5±18.5)mmHg(P<0.001,1 mmHg=0.133 kPa).Surgical success rate was 89%(49/55).Acute post-PBAV AR occurred in 18 patients,including 3 patients with RA≥3 grade.In-hospital complications occurred in 6 patients(2 deaths,2 cases of transient arrhythmia,and 2 cases of femoral artery embolization).Fifty patients accomplished the follow-up and the follow-up time was 6.2(3.4,8.5)years.Significant AR was found in 20 patients.Significant AR-free survival rate was 53%at 5 years and 19%at 10 years.Reintervention was performed in 11 patients(4 with valvuloplasty and 7 with v

关 键 词：主动脉瓣狭窄 经皮球囊主动脉瓣成形术 儿童 预后 

分 类 号：R726.5[医药卫生—儿科]