先天性主动脉瓣狭窄外科手术和介入治疗的对比研究  

Comparison of surgical repair and transcatheter balloon dilatation for congenital aortic stenosis

作　　者：朱奕帆 蒋琪 张文 胡仁杰 郁夏风 张海波[1] Zhu Yifan;Jiang Qi;Zhang Wen;Hu Renjie;Yu Xiafeng;Zhang Haibo(Department of Cardiothoracic Surgery,Shanghai Children’s Medical Center,Shanghai Jiaotong 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,200127

出　　处：《中华胸心血管外科杂志》2021年第10期586-590,共5页Chinese Journal of Thoracic and Cardiovascular Surgery

摘　　要：目的对比外科手术和介入手术治疗先天性主动脉瓣狭窄的结果。方法回顾性分析2008年1月至2019年12月诊断为先天性主动脉瓣狭窄并接受外科主动脉瓣成形术和内科球囊扩张术的患儿临床资料。记录并比较患儿术前资料、术中资料、近远期瓣膜功能,Kaplan-Meier分析近远期生存率和免于再手术率,logistic回归分析危险因素。结果116例接受外科瓣叶成形术(surgical aortic valvuloplasty,SAV),64例接受内科球囊扩张术(balloon dilation,BD)。两组患儿术前年龄、体质量、跨瓣峰值压差、主动脉瓣反流、左心室射血分数、左心室舒张末期直径Z值和主动脉瓣瓣环直径Z值均无统计学差异(P>0.05)。SAV组术后下降的跨瓣峰值压差和远期免于再手术率均优于BD组。随访SAV组(5.2±3.1)年,BD组(4.5±2.1)年。10年生存率两组无明显差异(P=0.51),10年免于再手术率差异有统计学意义(SAV组59.6%,BD组49.7%,P=0.01)。多因素分析提示:球囊扩张是再手术的独立风险因素(P=0.05)。结论SAV和BD均能有效地解除梗阻并保证生存率。SAV术后跨瓣峰值压差的降低和远期免于再手术率均优于BD。BD后再手术风险显著增加。Objective To compare the results of surgical valvuloplasty and balloon dilation in patients with aortic stenosis(AS)at our center.Methods We retrospectively reviewed the clinical data of children diagnosed with AS,underwent aortic repair or balloon dilation from January 2008 to December 2019.Seeking to analyze the early and long-term valvular function,evaluate mortality and freedom from reoperation by Kaplan-Meier method and figure out the risk factors by logistic regression.Results There were 116 patients having received surgical valvuloplasty(SAV)and 64 having received balloon dilation(BD).There were no significant differences between two groups respect to median age,weight,preoperative peek gradient,aortic insufficient degree,left ventricular ejection fraction left ventricular end-diastolic dimension Z-score and aortic anulus diameter Z-score(P>0.05).SAV achieved better gradient reduction and freedom from reoperation than did BD.The mean follow-up time was(5.2±3.1)years in SAV and(4.5±2.1)years in BD.Survival at 10 year was comparable between 2 groups(P=0.51).Freedom from reoperation at 10 years was 59.6%in SAV and 49.7%in BD respectively(P=0.01).Multivariate analysis revealed that BD contributed to subsequent reoperation(P=0.05).Conclusion SAV and BD both significantly relieved aortic stenosis and obtained good survival benefit.SAV yielded better gradient reduction and lower reoperation risk.BD might increase the hazard of reoperation.

关 键 词：先天性主动脉瓣狭窄 外科瓣叶成形术 主动脉瓣球囊扩张术 

分 类 号：R726.5[医药卫生—儿科]