Mitral valve orifice area predicts outcome after biventricular repair in patients with hypoplastic left ventricles.

IF 4.2 1区 医学 Q1 CARDIAC & CARDIOVASCULAR SYSTEMS
David Liddle, Addison Gearhart, Lynn A Sleeper, Minmin Lu, Eric Feins, David N Schidlow, Sunil Ghelani, Andrew J Powell, Sitaram Emani, Rebecca S Beroukhim
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引用次数: 0

Abstract

Background: Identification of risk factors for biventricular (BiV) repair in children with hypoplastic left ventricles (HLV) has been challenging. We sought to identify preoperative cardiovascular magnetic resonance (CMR) predictors of outcome in patients with HLVs who underwent BiV repair, with a focus on the mitral valve (MV).

Methods: Single-center retrospective analysis of preoperative CMRs on patients with HLV (≤50 mL/m2) and no endocardial fibroelastosis who underwent BiV repair from 2005-2022. CMR measurements included MV orifice area in diastole. The primary composite outcome included time to death, transplant, BiV takedown, heart failure admission, left atrial decompression, or unexpected reoperation; and the secondary outcome included more than or equal to moderate mitral stenosis and/or regurgitation.

Results: Median follow-up was 0.7 (interquartile range 0.1, 2.2) years. Of 122 patients [59 atrioventricular canal (AVC) and 63 non-AVC] age 3 ± 2.8 years at the time of BiV repair, freedom from the primary outcome at 2 years was 53% for AVC and 69% for non-AVC (log rank p = 0.12), and freedom from the secondary outcome at 2 years was 49% for AVC and 79% for non-AVC (log rank p < 0.01). Independent predictors of primary outcome for AVC patients included MV orifice area z-score <-2 and transitional AVC; for non-AVC patients, predictors included MV orifice area z-score <-2, abnormal MV anatomy, and conal-septal ventricular septal defect. Independent predictors of secondary outcome for AVC patients included older age at surgery, transitional AVC, and transposition of the great arteries.

Conclusion: In children with HLV, low MV orifice area and pre-existing MV pathology are risk factors for adverse outcome after BiV repair.

二尖瓣口面积可预测左心室发育不全患者双心室修复术后的效果
背景:鉴定左心室发育不全(HLV)儿童双心室(BiV)修复术的风险因素一直是一项挑战。我们试图确定接受双室修复术的 HLV 患者术前心血管磁共振(CMR)预测结果的因素,重点是二尖瓣(MV):单中心回顾性分析 2005-2022 年间接受 BiV 修复术的 HLV(≤50ml/m2)和无心内膜纤维增生症患者的术前 CMR。CMR 测量包括舒张期中流孔面积。主要复合结果包括死亡、移植、BiV撕裂、心衰入院、左房减压或意外再次手术的时间;次要结果包括≥中度二尖瓣狭窄和/或反流:中位随访时间为 0.7(IQR 0.1,2.2)年。122名患者中(48%为房室管(AVC),52%为非AVC),BiV修复时年龄为(3 ± 2.8)岁,2年后AVC患者无主要结果的比例为53%,非AVC患者为69%(对数秩p=0.12),2年后AVC患者无次要结果的比例为49%,非AVC患者为79%(对数秩p):在HLV患儿中,低中流道孔面积和先前存在的中流道病变是导致BiV修复术后不良预后的风险因素。
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来源期刊
CiteScore
10.90
自引率
12.50%
发文量
61
审稿时长
6-12 weeks
期刊介绍: Journal of Cardiovascular Magnetic Resonance (JCMR) publishes high-quality articles on all aspects of basic, translational and clinical research on the design, development, manufacture, and evaluation of cardiovascular magnetic resonance (CMR) methods applied to the cardiovascular system. Topical areas include, but are not limited to: New applications of magnetic resonance to improve the diagnostic strategies, risk stratification, characterization and management of diseases affecting the cardiovascular system. New methods to enhance or accelerate image acquisition and data analysis. Results of multicenter, or larger single-center studies that provide insight into the utility of CMR. Basic biological perceptions derived by CMR methods.
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