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IF 3.6 2区医学 Q1 CARDIAC & CARDIOVASCULAR SYSTEMS

Annals of Thoracic Surgery Pub Date : 2025-02-20 DOI:10.1016/j.athoracsur.2025.01.034

Teerapong Tocharoenchok, Kok Hooi Yap, Brigitte Mueller, Chun-Po Steve Fan, David J Barron, Osami Honjo

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引用次数: 0

摘要

背景：研究残余病灶评分（RLS）对 5 种常见先天性心脏病手术长期疗效的影响：研究残余病灶评分（RLS）对5种常见先天性心脏病手术长期疗效的影响：研究对象为 2000 年至 2012 年间接受完全性房室间隔缺损 (AVSD)、法洛氏四联症 (TOF)、大动脉外翻 (d-TGA)、单心室（Norwood 手术）和伴有室间隔缺损的共动脉症 (CoA/VSD) 手术并存活至出院的所有婴儿。根据修复后的临床和超声心动图评估结果对 RLS 进行评分（1 分-无/轻微，2 分-轻微，3 分-严重或针对此类病变进行院内再介入/再手术）。采用卡普兰-梅耶生存法和竞争风险模型对事件发生时间进行总结：共纳入 1027 例患者（213 例 AVSD、358 例 TOF、308 例 d-TGA、127 例单发心室和 21 例 CoA/VSD），中位随访时间为 15 年（IQR 11-18.4 年）。总体而言，227 名患者（22.1%）的 RLS 为 1 级，556 名患者（54.1%）的 RLS 为 2 级，244 名患者（23.8%）的 RLS 为 3 级。RLS与晚期死亡/移植无关。男性、TOF和ASO导致晚期死亡/移植的风险最低。15年后，14.5%的患者出现晚期再介入/再手术。年龄较小、TOF/PS修复、ASO、RLS为3（HR 2.02，CI 1.17-3.51，P=0.012）、术中手术翻修和院内再介入/再手术与晚期再介入/再手术有关：RLS不能预测晚期死亡率，但能预测先天性心脏修复术后的晚期再介入/再手术，可用于针对高危患者进行随访。

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The Association between Residual Lesion Score and Long-Term Outcomes of Congenital Cardiac Operations.

Background: To investigate the impact of residual lesion score (RLS) on the long-term outcomes of 5 common congenital heart operations.

Methods: All infants who underwent definitive surgery for complete atrioventricular septal defect (AVSD), tetralogy of Fallot (TOF), dextro-transposition of the great arteries (d-TGA), single ventricle (Norwood procedure), and coarctation with ventricular septal defect (CoA/VSD) between 2000 and 2012 who survived until discharge were studied. RLS scores (1 - no/trivial, 2 - minor, 3 - major or in-hospital reinterventions/reoperations for such lesions) were assigned based on post-repair clinical and echocardiographic evaluation. The time to events was summarized using the Kaplan-Meier survival method and competing risk models.

Results: 1027 patients were included (213 AVSDs, 358 TOFs, 308 d-TGAs, 127 single ventricles, and 21 CoA/VSDs) with a median follow-up time of 15 years (IQR 11-18.4 years). Overall, 227 patients (22.1%) had RLS of 1, 556 patients (54.1%) had RLS of 2, and 244 patients (23.8%) had RLS of 3. Freedom from late death/transplantation was 93.7% at 15 years. RLS was not associated with late death/transplantation. Male sex, TOF and ASO had the lowest risk for late death/transplantation. Late reintervention/reoperations were present in 14.5% at 15 years. Younger age, TOF/PS repair, ASO, RLS of 3 (HR 2.02, CI 1.17-3.51, p=0.012), intraoperative surgical revision, and in-hospital reintervention/reoperation associated with late reintervention/reoperation.

Conclusions: The RLS does not predict late mortality but predicts late reintervention/reoperation after congenital cardiac repair and can be used to target at-risk patients for follow-up.

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来源期刊

Annals of Thoracic Surgery 医学-呼吸系统

CiteScore

6.40

自引率

13.00%

发文量

1235

审稿时长

42 days

期刊介绍： The mission of The Annals of Thoracic Surgery is to promote scholarship in cardiothoracic surgery patient care, clinical practice, research, education, and policy. As the official journal of two of the largest American associations in its specialty, this leading monthly enjoys outstanding editorial leadership and maintains rigorous selection standards. The Annals of Thoracic Surgery features: • Full-length original articles on clinical advances, current surgical methods, and controversial topics and techniques • New Technology articles • Case reports • "How-to-do-it" features • Reviews of current literature • Supplements on symposia • Commentary pieces and correspondence • CME • Online-only case reports, "how-to-do-its", and images in cardiothoracic surgery. An authoritative, clinically oriented, comprehensive resource, The Annals of Thoracic Surgery is committed to providing a place for all thoracic surgeons to relate experiences which will help improve patient care.