초록접수 현황
| 15F-166 | 구연 발표 |
Long-term Outcome after Surgical Closure of Ventricular Septal Defect in Adults
방지현, 박정준, 윤태진, 박천수
울산대학교 의과대학 서울아산병원 흉부외과학교실 소아심장외과
Background : Although several clinical trials have presented the outcomes after closure of ventricular septal defect (VSD) in adult patients, there are limited data regarding the long term outcomes in a reasonably sized and contemporary cohort.
Methods : We reviewed 240 adult patients (mean age 33.4 years, range, 18.3 - 72.4 years) with VSD who underwent surgical closure in Korea between January 1989 to December 2013.
Results : VSDs were membranous (64.2%), subarterial (32.1%) and muscular outlet (3.7%). The indications of surgery were aortic regurgitation (49.1%), left ventricular volume overload (14.2%), infective endocarditis (14.2%), and pulmonary hypertension (9.2%). 80 patients required valve replacement or repair and 8 patients underwent concomitant Maze operation. There were two early deaths caused by postoperative low cardiac output syndrome, of whom, one had preoperative acute respiratory distress syndrome and another had severe pulmonary hypertension. Median follow-up was 135.1 months (range, 0.9-309.3months), with 11 late deaths and 4 strokes. Among 238 early survivors, 13 had atrial fibrillation or atrial flutter and 5 patients required permanent pacemaker implantation. During follow-up, 17 patients required reoperation (11, valve regurgitation; 3, infective endocarditis; 2, VSD leak; 1, heart transplantation). Event-free survival with end points defined as death, endocarditis or heart surgery was 94.8±0.2% at 5 years, 92.3±0.2% at 10 years, and 85.2±0.3% at 15 years. By multivariate analysis, preoperative pulmonary hypertension (P=0.02) was independent risk factor for mortality, whereas type of VSD closure, age more than 60 years and preoperative LV dysfunction were not. At last visit, 91.7% of all patients studied were symptom free and 77.1% of patients had no more medications. Left ventricular size by echocardiography was normal in 175 (72.9%) patients. Late residual VSDs were more common after patch closure (6 of 7 patients).
Conclusion : Outcome in adult patients who underwent VSD closure had low mortality and morbidity.
Methods : We reviewed 240 adult patients (mean age 33.4 years, range, 18.3 - 72.4 years) with VSD who underwent surgical closure in Korea between January 1989 to December 2013.
Results : VSDs were membranous (64.2%), subarterial (32.1%) and muscular outlet (3.7%). The indications of surgery were aortic regurgitation (49.1%), left ventricular volume overload (14.2%), infective endocarditis (14.2%), and pulmonary hypertension (9.2%). 80 patients required valve replacement or repair and 8 patients underwent concomitant Maze operation. There were two early deaths caused by postoperative low cardiac output syndrome, of whom, one had preoperative acute respiratory distress syndrome and another had severe pulmonary hypertension. Median follow-up was 135.1 months (range, 0.9-309.3months), with 11 late deaths and 4 strokes. Among 238 early survivors, 13 had atrial fibrillation or atrial flutter and 5 patients required permanent pacemaker implantation. During follow-up, 17 patients required reoperation (11, valve regurgitation; 3, infective endocarditis; 2, VSD leak; 1, heart transplantation). Event-free survival with end points defined as death, endocarditis or heart surgery was 94.8±0.2% at 5 years, 92.3±0.2% at 10 years, and 85.2±0.3% at 15 years. By multivariate analysis, preoperative pulmonary hypertension (P=0.02) was independent risk factor for mortality, whereas type of VSD closure, age more than 60 years and preoperative LV dysfunction were not. At last visit, 91.7% of all patients studied were symptom free and 77.1% of patients had no more medications. Left ventricular size by echocardiography was normal in 175 (72.9%) patients. Late residual VSDs were more common after patch closure (6 of 7 patients).
Conclusion : Outcome in adult patients who underwent VSD closure had low mortality and morbidity.
책임저자: 박천수
울산대학교 의과대학 서울아산병원 흉부외과학교실 소아심장외과
연락처 : 방지현, Tel: 010-2643-5777 , E-mail : mibbi@naver.com
