背景:静脉窦房间隔缺损(SVASD)是一种罕见的先天性心脏异常,占所有房间隔缺损的5%至10%。虽然手术闭合是SVASD的标准治疗方法,关于结局的数据仅限于小型队列.因此,我们对SVASD修复的结局进行了系统评价.
结果:主要结局是死亡。次要结果包括心房颤动,窦房结功能障碍,起搏器插入,脑血管意外,再操作,残余间隔缺损,上腔静脉阻塞,再植入肺静脉阻塞.使用随机效应模型计算结果的汇总发生率。包括40项研究,涉及1320例接受SVASD修复的患者。大多数是男性患者(55.4%),88.0%表现为相关的肺静脉连接异常。加权平均年龄为18.6±12.5岁,总体加权平均随访期为8.6±10.4年。住院死亡率为0.24%,据报道,780例患者的30天死亡率为0.5%。房颤发生率,窦房结功能障碍,起搏器插入,长期随访的脑血管意外为3.3%(2.18%-4.93%),6.5%(5.09%-8.2%),2.23%(1.34%-3.57%),和2.03%(0.89%-2.46%)。1.36%(0.68%-2.42%)的手术再次手术,残余间隔缺损占1.34%(0.69%-2.42%),上腔静脉阻塞占1.76%(1.02%-2.9%),再植入肺静脉阻塞占1.4%(0.7%-2.49%)。
结论:这是第一次对SVASD手术修复后的结果进行综合分析。研究结果肯定了手术的安全性和有效性,建立评估新出现的经导管治疗的参考点。与手术修复相当的安全性和有效性对于广泛采用经导管治疗至关重要。
BACKGROUND: Sinus venosus atrial septal defect (SVASD) is a rare congenital cardiac anomaly comprising 5% to 10% of all atrial septal defects. Although surgical closure is the standard treatment for SVASD, data on outcomes have been confined to small cohorts. Thus, we conducted a systematic review of the outcomes of SVASD repair.
RESULTS: The primary outcome was death. Secondary outcomes encompassed atrial fibrillation, sinus node dysfunction, pacemaker insertion, cerebrovascular accident, reoperation, residual septal defect, superior vena cava obstruction, and reimplanted pulmonary vein obstruction. Pooled incidences of outcomes were calculated using a random-effects model. Forty studies involving 1320 patients who underwent SVASD repair were included. The majority were male patients (55.4%), with 88.0% presenting with associated anomalous pulmonary venous connection. The weighted mean age was 18.6±12.5 years, and the overall weighted mean follow-up period was 8.6±10.4 years. The in-hospital mortality rate was 0.24%, with a 30-day mortality rate of 0.5% reported in 780 patients. Incidences of atrial fibrillation, sinus node dysfunction, pacemaker insertion, and cerebrovascular accident over the long-term follow-up were 3.3% (2.18%-4.93%), 6.5% (5.09%-8.2%), 2.23% (1.34%-3.57%), and 2.03% (0.89%-2.46%) respectively. Reoperation occurred in 1.36% (0.68%-2.42%) of surgeries, residual septal defect in 1.34% (0.69%-2.42%), superior vena cava obstruction in 1.76% (1.02%-2.9%), and reimplanted pulmonary vein obstruction in 1.4% (0.7%-2.49%).
CONCLUSIONS: This is the first comprehensive analysis of outcomes following surgical repair of SVASD. The findings affirm the safety and effectiveness of surgery, establishing a reference point for evaluating emerging transcatheter therapies. Safety and efficacy profiles comparable to surgical repair are essential for widespread adoption of transcatheter treatments.