先天性主动脉瓣狭窄首次干预后30年单中心结局
回顾性单中心队列研究纳入231例因孤立性重度先天性主动脉瓣狭窄接受首次干预的患者，比较球囊主动脉瓣成形术与外科主动脉瓣切开术的远期结局。总体10年生存率99.4%、25年生存率92.3%，两种策略间无统计学显著差异。再干预常见，尤其新生儿再干预率显著更高，但进展至主动脉瓣置换的比例较低。
要点
- 重度先天性主动脉瓣狭窄首次干预后远期生存优异，球囊与外科策略生存相当。
- 再干预常见，新生儿期干预者再干预风险显著更高。
- 进展至机械瓣或自体肺动脉瓣置换的比例相对较低。
核心结论
- 重度先天性主动脉瓣狭窄干预后远期生存优异，球囊主动脉瓣成形术与外科主动脉瓣切开术生存结局相当。
- 再干预常见，尤其新生儿，但进展至主动脉瓣置换较少。
研究设计与样本
- 回顾性单中心队列研究，纳入孤立性重度先天性主动脉瓣狭窄首次干预患者共231例。
- 分组为球囊主动脉瓣成形术96例、外科主动脉瓣切开术112例、其他23例。
- 采用Kaplan-Meier和Cox回归分析。
主要发现
- 外科组干预时中位年龄低于球囊组（0.2岁 vs 3.74岁，p<0.001）。
- 总体10年生存率99.4%，25年生存率92.3%，球囊组与外科组差异无统计学意义（p=0.083）。
- 总体49%患者发生再干预，球囊组与外科组再干预率相似（p=0.950）。
- 10年免于机械瓣或自体肺动脉瓣置换率为75%，25年为67%，两种策略差异无统计学意义（p=0.190）。
- 新生儿期干预与显著更低的免于再干预率相关（p<0.0001）。
关键数值与推荐
- 纳入标准为孤立性重度先天性主动脉瓣狭窄，定义为峰值压差>65 mm Hg和/或平均压差>40 mm Hg。
临床怎么用
- 支持继续采取多学科、基于解剖结构的决策方式管理重度先天性主动脉瓣狭窄。
- 强调全生命周期管理策略的重要性，并指出建立全国性主动脉瓣狭窄注册系统的必要性。
以上解读依据论文摘要（全文未开放获取或许可不允许翻译转载）。
原文
Objective To compare long-term outcomes following balloon aortic valvuloplasty (BAV) and surgical aortic valvotomy (SAV), including surgical valvuloplasty for isolated severe congenital aortic valve stenosis (AVS). Data for mechanical aortic valve replacement and pulmonary autograft replacement are also presented to provide a complete institutional cohort overview. Methods Retrospective single-centre cohort study including patients aged 65 mm Hg and/or mean gradient >40 mm Hg. Primary outcome was all-cause mortality. Secondary outcomes were time to reintervention and time to aortic valve replacement (AVR)—mechanical or autograft. Kaplan-Meier and Cox regression analyses were performed. Results A total of 231 patients met inclusion criteria (96 BAV, 112 SAV, 23 other). Median age at intervention was lower in the SAV group (0.2 years vs 3.74 years, p<0.001). Overall survival was 99.4% at 10 years and 92.3% at 25 years, with no statistically significant difference between BAV and SAV (p=0.083), though a trend may exist. Reintervention occurred in 49% of patients overall, with similar rates between BAV and SAV (p=0.950). Freedom from mechanical or autograft AVR remained high (75% at 10 years; 67% at 25 years), with no significant difference between strategies (p=0.190). Neonatal intervention was associated with significantly lower freedom from reintervention (p<0.0001). Conclusions Long-term survival following intervention for severe congenital AVS is excellent and comparable between BAV and SAV. Reintervention is common, particularly in neonates, but progression to AVR less so. These findings support continued multidisciplinary, anatomy-guided decision-making and highlight the importance of life-course management strategies. Development of a national AVS registry is indicated.
引用
- Open Heart：Long-term outcomes after primary intervention for congenital aortic valve stenosis: a 30-year single-centre experience
供执业医师工作参考，不替代临床判断；数值与分级以指南原文为准。