儿童室间隔缺损的杂交室壁周围手术：哈萨克斯坦单中心大队列研究
Hybrid periventricular surgery for ventricular septal defects in children: a single-center large-cohort study in Kazakhstan
传统儿童室间隔缺损（心脏左右心室之间的隔膜破口）修补需体外循环（CPB，用机器暂时代替心肺功能）开胸手术，创伤较大。杂交手术结合微创与导管技术，经右心室壁穿刺在跳动的心脏上放置封堵器。本研究在哈萨克斯坦首次开展该技术，回顾2016—2024年747例0—18岁患儿，27例出现并发症：7例早期一过性心律失常、10例在术后2周至3.5年间发生完全性房室传导阻滞、8例需转为体外循环手术。晚期传导阻滞与年龄大于5岁、缺损大于8 mm显著相关。作者据此提出患者选择流程，认为杂交手术是低长期并发症的可行替代方案。
为什么推荐给您：已知杂交术式在哈萨克斯坦的首次大队列经验，属技术推广与风险因素分析。
不需要生物学背景，多打比方
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摘要Abstract
BACKGROUND: The hybrid technique for ventricular septal defect (VSD) closure combines elements of conventional open-heart surgery with cardiopulmonary bypass (CPB) and minimally invasive approaches, including beating-heart occluder implantation through right ventricular free-wall puncture. Hybrid periventricular VSD closure offers several advantages over CPB-based surgery. Its less invasive nature, facilitated by catheter-based access to the defect, may reduce anesthesia duration and hospital stay in pediatric patients. Despite these potential benefits, the adoption of hybrid VSD correction remains limited, particularly in Kazakhstan.
METHODS: We report our experience with hybrid VSD closure in 747 pediatric patients (age range: 0-18 years) treated between 2016 and 2024, representing the first implementation of this technique in Kazakhstan. We evaluated the impact of pre-, peri-, and postoperative variables, including VSD size and type, occluder characteristics, duration of anesthesia, and mechanical ventilation, on the risk of early or late rhythm disturbances and the need for conversion to CPB.
RESULTS: Postoperative complications occurred in 27 of 747 patients. Seven patients developed early transient rhythm disturbances, 10 experienced complete atrioventricular block (cAVB) between 2 weeks and 3.5 years after surgery, and 8 required conversion to CPB. Early transient rhythm disturbances were not associated with any analyzed factors. In contrast, late cAVB was significantly associated with older age (>5 years) and larger VSD size (>8 mm). Inlet VSD morphology, larger VSD size, and their combination were significant predictors of CPB conversion. Based on these findings, we propose an algorithm for patient selection for minimally invasive hybrid VSD closure.
CONCLUSIONS: Several clinical and anatomical factors should be considered when assessing perioperative and long-term risks of hybrid VSD closure in pediatric patients. Nevertheless, the hybrid approach represents a valuable alternative to conventional surgery, demonstrating a low incidence of long-term complications.