Prognostic Effects of Operation Age for Pediatric Patients with Supravalvar Aortic Stenosis.

IF 1.9 4区医学 Q3 CARDIAC & CARDIOVASCULAR SYSTEMS Reviews in cardiovascular medicine Pub Date : 2024-10-25 eCollection Date: 2024-10-01 DOI:10.31083/j.rcm2510384

Lizhi Lv, Yuekun Sun, Simeng Zhang, Aihua Zhi, Cheng Wang, Qiang Wang

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Abstract

Background: The appropriate age for surgical repair of asymptomatic congenital supravalvular aortic stenosis (SVAS) is still unknown. The purpose of this research was to assess the safety and effectiveness of various operation ages when managing SVAS.

Methods: Consecutive asymptomatic SVAS pediatric patients in the Beijing Fuwai and Yunnan Fuwai hospitals over a period of 18 years were retrospectively analyzed. Patients were classified as follows: age <2.0 years (y) (n = 84), 2.0-5.0 y (n = 72), and >5.0 y (n = 92). The primary safety endpoint was in-hospital death or extracorporeal membrane oxygenation (ECMO) needed. The primary effectiveness outcome was re-operation or restenosis during follow-up. To calculate the hazard ratios (HR), Cox regression with inverse probability of treatment weighted was utilized.

Results: At the time of surgery, the median age of the 248 patients that were included was 4 y (interquartile range (IQR): 1.8-6.5). For the primary safety outcome, 7 (8.3%) patients in the age <2.0 y group had in-hospital death or ECMO needed, while no patients in the age 2.0-5.0 y and age>5.0 y groups (p = 0.001). The median follow-up was 25.5 months (IQR: 7.0-59.0). Compared with the age 2.0-5.0 y group, the age <2.0 y group and age >5.0 y group had a higher risk of re-operation or restenosis (age <2.0 y, HR = 3.27, 95% CI 1.25-8.60; age >5.0 y, HR = 2.87, 95% CI 1.19-6.91).

Conclusions: Asymptomatic children with SVAS without other cardiovascular abnormalities should be considered for delayed surgical intervention until 2 years of age, and then surgery should be conducted as soon as possible. Children with severe symptoms should undergo surgery immediately, regardless of age.

Clinical trial registration: ChiCTR2300067851, https://www.chictr.org.cn/showproj.html?proj=177491.

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主动脉瓣上狭窄儿科患者手术年龄的预后影响

背景：对无症状先天性瓣上主动脉瓣狭窄（SVAS）进行手术修复的合适年龄仍然未知。本研究旨在评估不同手术年龄在处理 SVAS 时的安全性和有效性：方法：对北京阜外医院和云南阜外医院 18 年来连续收治的无症状 SVAS 儿科患者进行回顾性分析。患者分类如下：年龄 5.0 岁（n = 92）。主要安全终点是院内死亡或需要体外膜肺氧合（ECMO）。主要有效性结局是随访期间再次手术或再狭窄。为了计算危险比（HR），采用了治疗加权逆概率的考克斯回归法：248名患者手术时的中位年龄为4岁（四分位间距（IQR）：1.8-6.5）。就主要安全性结果而言，5.0 岁组中有 7 例（8.3%）患者（P = 0.001）。中位随访时间为 25.5 个月（IQR：7.0-59.0）。与 2.0-5.0 岁组相比，5.0 岁组再次手术或再狭窄的风险更高（5.0 岁，HR = 2.87，95% CI 1.19-6.91）：无症状、无其他心血管异常的SVAS患儿应考虑延迟手术治疗至2岁，然后尽快进行手术。症状严重的儿童应立即接受手术，无论年龄大小：临床试验注册：ChiCTR2300067851，https://www.chictr.org.cn/showproj.html?proj=177491。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Reviews in cardiovascular medicine 医学-心血管系统

CiteScore

2.70

自引率

3.70%

发文量

377

审稿时长

1 months

期刊介绍： RCM is an international, peer-reviewed, open access journal. RCM publishes research articles, review papers and short communications on cardiovascular medicine as well as research on cardiovascular disease. We aim to provide a forum for publishing papers which explore the pathogenesis and promote the progression of cardiac and vascular diseases. We also seek to establish an interdisciplinary platform, focusing on translational issues, to facilitate the advancement of research, clinical treatment and diagnostic procedures. Heart surgery, cardiovascular imaging, risk factors and various clinical cardiac & vascular research will be considered.