小儿离散性膜性主动脉下狭窄手术修复后主动脉瓣的命运。

IF 4.4 1区医学 Q1 CARDIAC & CARDIOVASCULAR SYSTEMS

Journal of Thoracic and Cardiovascular Surgery Pub Date : 2025-10-01 DOI:10.1016/j.jtcvs.2025.05.013

Jie Dong MD , Ziping Li MD , Yangxue Sun MD , Chuhao Du MD , Shun Liu MD , Keming Yang MD, PhD , Xiangbin Pan MD, PhD , Shuo Dong MD, PhD

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引用次数: 0

摘要

目的：本研究旨在评估儿童离散性膜性主动脉下狭窄（DMSS）手术修复后主动脉瓣（AV）功能的长期预后，确定严重主动脉反流（SAR）和左心室流出道梗阻（LVOTO）复发的预测因素，并建立长期管理的评分模型。方法：这项单中心、回顾性队列研究分析了2008年至2022年间219例接受DMSS手术修复的儿童患者。主要终点是SAR和LVOTO的复发率，中位随访时间为7.0年。采用多变量Cox回归分析建立预测模型，并使用自举重采样和校准图进行验证。基于显著性预测因子构建了nomogram风险分层模型。结果：SAR发生率为10.0%，LVOTO复发率为9.59%。复合终点的经历率为16.9%，1年、2年、5年和10年的自由率分别为99.5%、97.7%、93.4%和74.9%。最终模型包括房室离散性膜堆积，术前主动脉反流(AR)≥3级，房室剥离，旁路时间bbb75分钟，术后AR≥2级。该模型预测预后的测试集c指数为0.814，具有明显的将患者分层为低危和高危组的能力（P < 0.001）。结论：本研究突出了儿童DMSS术后SAR和LVOTO复发的关键危险因素，并为临床决策提供了可靠的风险分层模型。

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The fate of aortic valve after surgical repair for discrete membranous subaortic stenosis in pediatric patients

Objectives

This study aimed to evaluate the long-term outcomes of aortic valve function and identify predictors of significant aortic regurgitation and left ventricular outflow tract obstruction recurrence after surgical repair of discrete membranous subaortic stenosis in pediatric patients and to develop a scoring model for long-term management.

Methods

This single-center, retrospective cohort study analyzed 219 pediatric patients who underwent surgical repair for discrete membranous subaortic stenosis between 2008 and 2022. The primary end point was the composite of significant aortic regurgitation and left ventricular outflow tract obstruction recurrence assessed during a median follow-up of 7.0 years. Multivariable Cox regression analysis was used to develop a predictive model validated using bootstrap resampling and calibration plots. A nomogram and risk-stratification model were constructed based on significant predictors.

Results

Significant aortic regurgitation occurred in 10.0% of patients, and left ventricular outflow tract obstruction recurrence was observed in 9.59% of patients. The composite end point was experienced by 16.9%, with freedom rates from the end point at 1, 2, 5, and 10 years of 99.5%, 97.7%, 93.4%, and 74.9%, respectively. The final model included discrete membrane accumulation on the aortic valve, preoperative aortic regurgitation grade 3 or greater, peeling from aortic valve, bypass time more than 75 minutes, and postoperative aortic regurgitation grade 2 or greater. The model predicted the outcome with a C-index of 0.814 on the test set and exhibited a significant ability in stratification of patients into low-risk and high-risk groups (P < .001).

Conclusions

This study highlights key risk factors for significant aortic regurgitation and left ventricular outflow tract obstruction recurrence after discrete membranous subaortic stenosis surgery in pediatric patients and provides a robust risk-stratification model for clinical decision-making.

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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.