外科治疗67例婴儿先天性主动脉瓣狭窄的临床疗效分析  

Outcomes of surgical treatments of congenital aortic stenosis in 67 infants.

作　　者：朱奕帆 蒋琪 胡杰 张文 胡仁杰 董卫 张海波[1] Zhu Yifan;Jiang Qi;Hu Jie;Zhang Wen;Hu Renjie;Dong Wei;Zhang Haibo(Department of Cardiothoracic Surgery,Shanghai Children's Medical Center,Shanghai Jiao Tong University School of Medicine,Shanghai 200127,China.)

机构地区：[1]上海交通大学医学院附属上海儿童医学中心心胸外科,上海市200127

出　　处：《临床小儿外科杂志》2021年第6期512-517,共6页Journal of Clinical Pediatric Surgery

基　　金：上海聚德慈善基金资助项目。

摘　　要：目的先天性主动脉瓣狭窄是一种较常见但可能需要多次干预且伴随终身的先心病,本研究旨在探讨婴儿先天性主动脉瓣狭窄外科修复术的诊疗经验。方法回顾性收集2008年1月至2020年12月在上海儿童医学中心诊断为先天性主动脉瓣狭窄,并接受主动脉瓣成形术的婴儿作为研究对象,记录并分析患者术前资料、术中资料、近远期瓣膜功能、远期生存率和免于再手术、主动脉瓣置换等情况。结果67例接受外科瓣膜修复术的患者中位年龄为140(107~246)d,中位体重为6.2(4.6~7.5)kg,其中两叶瓣畸形27例(40.3%)。术前平均跨瓣峰值压差(70.2±24.5)mmHg,1例术前合并中度反流。早期死亡1例,远期死亡1例,平均随访时间(5.4±3.2)年,10年生存率95.8%,10年免于再手术率72.7%,10年免于主动脉瓣置换率78.9%。多因素分析发现:术前主动脉瓣环直径的Z值[HR:0.304,95%CI(0.104,0.891)]是导致再手术的独立危险因素(P=0.03)。结论婴儿先天性主动脉瓣狭窄修复术是一种安全有效的方法,可为后期治疗策略的制定嬴得足够的时间,从而获得更明确的解决方案。患者主动脉瓣环发育过小是再手术的危险因素。Objective Congenital aortic stenosis(AS)is a common congenital heart disease with a lifelong hazard of secondary interventions.This study was intended to explore the experience of surgical repair of aortic stenosis in infants.Methods Retrospective review was performed for clinical data of AS infants undergoing aortic repair from January 2008 to December 2020.And early and long-term valvular function,mortality and freedom from reoperation and aortic valve replacment(AVR)were analyzed.Results The median age of 67 patients undergoing surgical valve repair was 140(107-246)days and median operative weight 6.2(4.6-75)kg.And 27 cases were of biscuspid.The mean peak gradient across the valve was(70.2±24.5)mmHg and 1 child developed moderate aortic insufficiency.There was 1 early mortality and 1 late mortality.The mean follow-up period was(5.4±3.2)years.Time-related survival at 10 year was 95.8%.Freedom from reoperation and AVR was 72.7%and 78.9%respectively.Multivariate analysis revealed that Z-score of aortic annulus[HR 0.302,95%CI(0.091,1.006),P=0.031]was an independent risk factor of reoperation.Conclusion Congenital aortic valve repair in infants is both safe and effective to provide enough time to achieve a more definitive solution.Hypoplasty of aortic annulus increases reoperative hazard.

关 键 词：主动脉瓣狭窄/先天性 主动脉瓣狭窄/外科学 心脏瓣膜假体植入 治疗结果 

分 类 号：R541.1[医药卫生—心血管疾病] R493.28[医药卫生—内科学]