Risk factors for recurrent left ventricular outflow tract obstruction after surgical repair for subaortic stenosis
10.3760/cma.j.cn112434-20230402-00074
- VernacularTitle:主动脉瓣下狭窄外科手术后复发性左心室流出道梗阻危险因素分析
- Author:
Jie DONG
1
;
Shun LIU
;
Shuo DONG
;
Mengxuan ZOU
;
Chuhao DU
;
Yangxue SUN
;
Haitao XU
;
Jiashu SUN
;
Qiang WANG
;
Shoujun LI
;
Keming YANG
;
Jun YAN
Author Information
1. 中国医学科学院 北京协和医学院 国家心血管病中心 阜外医院小儿外科中心，北京 100037
- Keywords:
Subaortic stenosis;
Left ventricular outflow tract obstruction;
Congenital heart disease;
Cardiac surgery
- From:
Chinese Journal of Thoracic and Cardiovascular Surgery
2023;39(10):599-604
- CountryChina
- Language:Chinese
-
Abstract:
Objective:To investigate the prognosis and risk factors for children diagnosed with all types of subaortic stenosis(SAS) who developed recurrent left ventricular outflow tract obstruction after surgical treatment.Methods:The study retrospectively included patients aged 0-18 years old who underwent open heart SAS surgery at Fuwai Hospital from 2016-2019. Children with hypertrophic obstructive cardiomyopathy were excluded. Detailed operative notes, medical records and ultrasound information, and follow-ups were extracted. Recurrent SAS was defined as left ventricular outflow tract gradient 30 mmHg(1 mmHg=0.133 kPa) 1 month after SAS surgical treatment.Results:A total of 137 children were included in this study. The medium age of children at the time of SAS surgery was 4.6 years old(3 months-17.8 years old). After a median follow-up of 4.36 years(3.2-5.7 years), a total of 30 patients developed recurrent LVOTO, with a recurrence rate of 21.9%, and 7(5.1%) underwent a second surgery. Compared to the non-recurrent group, children in the recurrent group were younger at the time of surgery( P=0.0443), had a smaller body surface area( P=0.0485), and a longer length of stay( P=0.0380). In Cox analysis, when only considering preoperative variables, the independent risk factor for LVOTO recurrence were a peak left ventricular outflow tract gradient higher than 50 mmHg( HR=5.25, P=0.001), a BSA less than 0.9( HR=2.5, P=0.023), and a length of SAS 5 mm( HR=2.29, P=0.050). When both preoperative and intraoperative variables were considered, preoperative peak left ventricular outflow tract gradient 50 mmHg( HR=4.91, P=0.002) and peeling from the aortic valve( HR=3.23, P=0.010) were independent risk factors for postoperative recurrence. Conclusion:Recurrent LVOTO after SAS surgical repair is common, and regular postoperative follow-up is crucial to evaluate whether a secondary intervention is required. Regular postoperative follow-up is needed for children at high risk.
