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Abstract：
OBJECTIVE: The aim of this study was to identify the prevalence and anatomic characteristics of coronary artery lesions and their associated postoperative risk in patients undergoing supravalvular aortic stenosis repair.
METHODS: The association between structural risk factors, postoperative ST-segment changes, and major adverse cardiac events was explored using logistic regression and the Fisher\'s exact test.
RESULTS: In 51 consecutive patients with supravalvular aortic stenosis treated between 2000 and 2017, a total of 48 coronary lesions were identified in 27 patients (53%). Prominent ostial ridge (type I) was the most common coronary lesion, followed by small ostium with (IIIb) or without (IIIa) diffuse long-segment coronary narrowing, and adhesion of the coronary cusp (type II). There were 54 concomitant coronary procedures, including 43 primary corrections and 11 revisions. Thirty-three patients underwent supravalvular aortic stenosis repair with a bifurcated patch, of which 13 (39.4%) had right coronary artery distortion/kinking requiring patch plication (n = 8) and reimplantation (n = 5). Postoperative major adverse cardiac events (MACE) occurred in 9 patients (17.6%), including 3 deaths, 4 needing mechanical circulatory support, and 6 experiencing ventricular arrhythmias. Twenty-two patients (43.1%) had postoperative ST-segment changes, including 13 early changes that resolved within 24 h and 9 persistent changes lasting >24 h. Patients with type III lesions were associated with postoperative persistent ST-segment change (P = 0.04) and these lesions independently predicted postoperative MACE (P = 0.02). Patients with pre-existing coronary lesions were at elevated risk of right coronary artery distortion/kinking (P = 0.045).
CONCLUSIONS: The prevalence of ST-segment changes and MACE is high in patients undergoing supravalvular aortic stenosis repair. The preoperative presence of complex coronary lesions is the most important predictor for postoperative major adverse cardiac events.
METHODS: The association between structural risk factors, postoperative ST-segment changes, and major adverse cardiac events was explored using logistic regression and the Fisher\'s exact test.
RESULTS: In 51 consecutive patients with supravalvular aortic stenosis treated between 2000 and 2017, a total of 48 coronary lesions were identified in 27 patients (53%). Prominent ostial ridge (type I) was the most common coronary lesion, followed by small ostium with (IIIb) or without (IIIa) diffuse long-segment coronary narrowing, and adhesion of the coronary cusp (type II). There were 54 concomitant coronary procedures, including 43 primary corrections and 11 revisions. Thirty-three patients underwent supravalvular aortic stenosis repair with a bifurcated patch, of which 13 (39.4%) had right coronary artery distortion/kinking requiring patch plication (n = 8) and reimplantation (n = 5). Postoperative major adverse cardiac events (MACE) occurred in 9 patients (17.6%), including 3 deaths, 4 needing mechanical circulatory support, and 6 experiencing ventricular arrhythmias. Twenty-two patients (43.1%) had postoperative ST-segment changes, including 13 early changes that resolved within 24 h and 9 persistent changes lasting >24 h. Patients with type III lesions were associated with postoperative persistent ST-segment change (P = 0.04) and these lesions independently predicted postoperative MACE (P = 0.02). Patients with pre-existing coronary lesions were at elevated risk of right coronary artery distortion/kinking (P = 0.045).
CONCLUSIONS: The prevalence of ST-segment changes and MACE is high in patients undergoing supravalvular aortic stenosis repair. The preoperative presence of complex coronary lesions is the most important predictor for postoperative major adverse cardiac events.
摘要：
目的：了解主动脉瓣上狭窄修补术患者冠状动脉病变的发生率、解剖特征及其术后风险。
方法：结构风险因素之间的关联，术后ST段改变,主要不良心脏事件采用logistic回归和Fisher精确检验。
结果：在2000年至2017年期间的51例连续瓣上主动脉瓣狭窄患者中，27例患者（53％）共发现48个冠状动脉病变。口脊突出（I型）是最常见的冠状动脉病变，其次是小口（IIIb）或不（IIIa）弥漫性长段冠状动脉狭窄，冠状尖点粘连(Ⅱ型)。有54例伴随冠状动脉手术，包括43次主要更正和11次修订。33例患者接受了分叉补片的瓣上主动脉瓣狭窄修复术；13例（39.4％）患有右冠状动脉扭曲/扭结，需要补片折叠（n=8）和重新植入（n=5）。术后发生MACE9例(17.6%),包括三人死亡,四个需要机械循环支持，和六种室性心律失常.22例(43.1%)患者术后ST段改变,包括13个在24小时内解决的早期更改，和9个持续超过24小时的持续变化。III型病变患者与术后持续性ST段改变相关（p=0.04），并独立预测术后MACE（p=0.02）。预先存在冠状动脉病变的患者右冠状动脉扭曲/扭结的风险升高（p=0.045）。
结论：主动脉瓣上狭窄修补术患者的ST段改变和MACE发生率较高。术前存在复杂冠状动脉病变是术后主要不良心脏事件的最重要预测因素。
方法：结构风险因素之间的关联，术后ST段改变,主要不良心脏事件采用logistic回归和Fisher精确检验。
结果：在2000年至2017年期间的51例连续瓣上主动脉瓣狭窄患者中，27例患者（53％）共发现48个冠状动脉病变。口脊突出（I型）是最常见的冠状动脉病变，其次是小口（IIIb）或不（IIIa）弥漫性长段冠状动脉狭窄，冠状尖点粘连(Ⅱ型)。有54例伴随冠状动脉手术，包括43次主要更正和11次修订。33例患者接受了分叉补片的瓣上主动脉瓣狭窄修复术；13例（39.4％）患有右冠状动脉扭曲/扭结，需要补片折叠（n=8）和重新植入（n=5）。术后发生MACE9例(17.6%),包括三人死亡,四个需要机械循环支持，和六种室性心律失常.22例(43.1%)患者术后ST段改变,包括13个在24小时内解决的早期更改，和9个持续超过24小时的持续变化。III型病变患者与术后持续性ST段改变相关（p=0.04），并独立预测术后MACE（p=0.02）。预先存在冠状动脉病变的患者右冠状动脉扭曲/扭结的风险升高（p=0.045）。
结论：主动脉瓣上狭窄修补术患者的ST段改变和MACE发生率较高。术前存在复杂冠状动脉病变是术后主要不良心脏事件的最重要预测因素。
