法洛氏四联症修复术后再干预的负担：30年来儿科和成人先天性疾病的共同经验。

IF 4.9 1区医学 Q1 CARDIAC & CARDIOVASCULAR SYSTEMS

Journal of Thoracic and Cardiovascular Surgery Pub Date : 2024-10-03 DOI:10.1016/j.jtcvs.2024.09.042

Shouka Parvin Nejad PhD , Crystal Tran BHSc , Adriana Goraieb , Gazelle Halajha BHSc , Sangkavi Kuhan BHSc , Sudipta Saha MMath , Marisa Signorile MMath , Chun-Po Steve Fan PhD , David Barron MD , Erwin Oechslin MD , Leland Benson MD , Rachel D. Vanderlaan MD, PhD

{"title":"法洛氏四联症修复术后再干预的负担：30年来儿科和成人先天性疾病的共同经验。","authors":"Shouka Parvin Nejad PhD , Crystal Tran BHSc , Adriana Goraieb , Gazelle Halajha BHSc , Sangkavi Kuhan BHSc , Sudipta Saha MMath , Marisa Signorile MMath , Chun-Po Steve Fan PhD , David Barron MD , Erwin Oechslin MD , Leland Benson MD , Rachel D. Vanderlaan MD, PhD","doi":"10.1016/j.jtcvs.2024.09.042","DOIUrl":null,"url":null,"abstract":"<div><h3>Objective</h3><div>There is a high burden of reintervention after repair of tetralogy of Fallot (TOF). We compare procedural burden and late outcomes in valve-sparing repair (VSR) and transannular patch (TAP) cohorts over 30 years.</div></div><div><h3>Methods</h3><div>Patients undergoing TOF repair (1990-2021, excluding complex TOF) were included in this study (n = 1239) with subsequent comparisons between TAP (n = 550) and VSR (n = 648) cohorts. Descriptive statistics, cumulative incidence frequencies, survival analysis, and propensity matching (n = 425) were used to analyze reintervention burden and survival.</div></div><div><h3>Results</h3><div>Overall survival of the cohort was 96.7% at 15 years and 95.6% at 25 years, with similar survival between TAP and VSR cohorts (<em>P</em> = .22). The TAP cohort had increased incidence of procedural burden at 25 years (TAP 69.8% vs VSR 37.2%; <em>P</em> < .001), with 34.6% undergoing ≥2 reinterventions. The TAP cohort had higher incidence of surgical pulmonary valve replacement at 15 years (TAP 20.7% vs VSR 7.6%; <em>P</em> < .001) and placement of pulmonary artery stents (TAP 20.2% vs VSR 4.9%; <em>P</em> < .001). By contrast, VSR had higher incidence of right ventricular outflow tract (RVOT) reoperation at 15 years (VSR 7.3% vs TAP 3.6%; <em>P</em> = .047). After propensity score matching there was no survival advantage between the VSR and TAP cohorts (Era 2), whereas the need for RVOT reoperation was not different between the 2 cohorts (<em>P</em> = .060).</div></div><div><h3>Conclusions</h3><div>The procedural burden remains high following TOF repair. TAP is associated with higher procedural burden in matched and nonmatched cohorts. VSR has increased risk of reoperation for RVOT obstruction only in nonmatched comparisons. Anatomical complexity and surgical repair strategy influence procedural burden following TOF repair.</div></div>","PeriodicalId":49975,"journal":{"name":"Journal of Thoracic and Cardiovascular Surgery","volume":"169 3","pages":"Pages 985-998.e4"},"PeriodicalIF":4.9000,"publicationDate":"2024-10-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":"{\"title\":\"Burden of reintervention after tetralogy of Fallot repair: A joint pediatric and adult congenital experience over 30 years\",\"authors\":\"Shouka Parvin Nejad PhD , Crystal Tran BHSc , Adriana Goraieb , Gazelle Halajha BHSc , Sangkavi Kuhan BHSc , Sudipta Saha MMath , Marisa Signorile MMath , Chun-Po Steve Fan PhD , David Barron MD , Erwin Oechslin MD , Leland Benson MD , Rachel D. Vanderlaan MD, PhD\",\"doi\":\"10.1016/j.jtcvs.2024.09.042\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<div><h3>Objective</h3><div>There is a high burden of reintervention after repair of tetralogy of Fallot (TOF). We compare procedural burden and late outcomes in valve-sparing repair (VSR) and transannular patch (TAP) cohorts over 30 years.</div></div><div><h3>Methods</h3><div>Patients undergoing TOF repair (1990-2021, excluding complex TOF) were included in this study (n = 1239) with subsequent comparisons between TAP (n = 550) and VSR (n = 648) cohorts. Descriptive statistics, cumulative incidence frequencies, survival analysis, and propensity matching (n = 425) were used to analyze reintervention burden and survival.</div></div><div><h3>Results</h3><div>Overall survival of the cohort was 96.7% at 15 years and 95.6% at 25 years, with similar survival between TAP and VSR cohorts (<em>P</em> = .22). The TAP cohort had increased incidence of procedural burden at 25 years (TAP 69.8% vs VSR 37.2%; <em>P</em> < .001), with 34.6% undergoing ≥2 reinterventions. The TAP cohort had higher incidence of surgical pulmonary valve replacement at 15 years (TAP 20.7% vs VSR 7.6%; <em>P</em> < .001) and placement of pulmonary artery stents (TAP 20.2% vs VSR 4.9%; <em>P</em> < .001). By contrast, VSR had higher incidence of right ventricular outflow tract (RVOT) reoperation at 15 years (VSR 7.3% vs TAP 3.6%; <em>P</em> = .047). After propensity score matching there was no survival advantage between the VSR and TAP cohorts (Era 2), whereas the need for RVOT reoperation was not different between the 2 cohorts (<em>P</em> = .060).</div></div><div><h3>Conclusions</h3><div>The procedural burden remains high following TOF repair. TAP is associated with higher procedural burden in matched and nonmatched cohorts. VSR has increased risk of reoperation for RVOT obstruction only in nonmatched comparisons. Anatomical complexity and surgical repair strategy influence procedural burden following TOF repair.</div></div>\",\"PeriodicalId\":49975,\"journal\":{\"name\":\"Journal of Thoracic and Cardiovascular Surgery\",\"volume\":\"169 3\",\"pages\":\"Pages 985-998.e4\"},\"PeriodicalIF\":4.9000,\"publicationDate\":\"2024-10-03\",\"publicationTypes\":\"Journal Article\",\"fieldsOfStudy\":null,\"isOpenAccess\":false,\"openAccessPdf\":\"\",\"citationCount\":\"0\",\"resultStr\":null,\"platform\":\"Semanticscholar\",\"paperid\":null,\"PeriodicalName\":\"Journal of Thoracic and Cardiovascular Surgery\",\"FirstCategoryId\":\"3\",\"ListUrlMain\":\"https://www.sciencedirect.com/science/article/pii/S002252232400895X\",\"RegionNum\":1,\"RegionCategory\":\"医学\",\"ArticlePicture\":[],\"TitleCN\":null,\"AbstractTextCN\":null,\"PMCID\":null,\"EPubDate\":\"\",\"PubModel\":\"\",\"JCR\":\"Q1\",\"JCRName\":\"CARDIAC & CARDIOVASCULAR SYSTEMS\",\"Score\":null,\"Total\":0}","platform":"Semanticscholar","paperid":null,"PeriodicalName":"Journal of Thoracic and Cardiovascular Surgery","FirstCategoryId":"3","ListUrlMain":"https://www.sciencedirect.com/science/article/pii/S002252232400895X","RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q1","JCRName":"CARDIAC & CARDIOVASCULAR SYSTEMS","Score":null,"Total":0}

引用次数: 0

摘要

目的：法洛氏四联症（TOF）修复术后再介入的负担很重。我们比较了 30 年来瓣膜修补术（VSR）和经瓣膜修补术（TAP）的手术负担和后期疗效：本研究纳入了接受TOF修补术的患者（1990-2021年，不包括复杂TOF）（人数=1239），随后对TAP（人数=550）和VSR（人数=648）队列进行了比较。研究采用了描述性统计、累积发病率频率、生存分析和倾向匹配（n=425）来分析再介入负担和生存率：结果：15 年和 25 年的总体存活率分别为 96.7%和 95.6%，TAP 和 VSR 组间的存活率相似（P=0.22）。TAP队列在25年时的手术负担发生率增加（TAP 69.8%对VSR 37.2%，P结论：TOF修复术后的手术负担仍然很高。在匹配和非匹配队列中，TAP 与较高的手术负担相关。VSR 仅在非匹配比较中增加了因 RVOT 阻塞而再次手术的风险。解剖复杂性和手术修复策略会影响 TOF 修复术后的手术负担。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

查看原文本刊更多论文

Burden of reintervention after tetralogy of Fallot repair: A joint pediatric and adult congenital experience over 30 years

Objective

There is a high burden of reintervention after repair of tetralogy of Fallot (TOF). We compare procedural burden and late outcomes in valve-sparing repair (VSR) and transannular patch (TAP) cohorts over 30 years.

Methods

Patients undergoing TOF repair (1990-2021, excluding complex TOF) were included in this study (n = 1239) with subsequent comparisons between TAP (n = 550) and VSR (n = 648) cohorts. Descriptive statistics, cumulative incidence frequencies, survival analysis, and propensity matching (n = 425) were used to analyze reintervention burden and survival.

Results

Overall survival of the cohort was 96.7% at 15 years and 95.6% at 25 years, with similar survival between TAP and VSR cohorts (P = .22). The TAP cohort had increased incidence of procedural burden at 25 years (TAP 69.8% vs VSR 37.2%; P < .001), with 34.6% undergoing ≥2 reinterventions. The TAP cohort had higher incidence of surgical pulmonary valve replacement at 15 years (TAP 20.7% vs VSR 7.6%; P < .001) and placement of pulmonary artery stents (TAP 20.2% vs VSR 4.9%; P < .001). By contrast, VSR had higher incidence of right ventricular outflow tract (RVOT) reoperation at 15 years (VSR 7.3% vs TAP 3.6%; P = .047). After propensity score matching there was no survival advantage between the VSR and TAP cohorts (Era 2), whereas the need for RVOT reoperation was not different between the 2 cohorts (P = .060).

Conclusions

The procedural burden remains high following TOF repair. TAP is associated with higher procedural burden in matched and nonmatched cohorts. VSR has increased risk of reoperation for RVOT obstruction only in nonmatched comparisons. Anatomical complexity and surgical repair strategy influence procedural burden following TOF repair.

求助全文

通过发布文献求助，成功后即可免费获取论文全文。去求助

来源期刊

Journal of Thoracic and Cardiovascular Surgery 医学-呼吸系统

CiteScore

11.20

自引率

10.00%

发文量

1079

审稿时长

68 days

期刊介绍： The Journal of Thoracic and Cardiovascular Surgery presents original, peer-reviewed articles on diseases of the heart, great vessels, lungs and thorax with emphasis on surgical interventions. An official publication of The American Association for Thoracic Surgery and The Western Thoracic Surgical Association, the Journal focuses on techniques and developments in acquired cardiac surgery, congenital cardiac repair, thoracic procedures, heart and lung transplantation, mechanical circulatory support and other procedures.