Faidutti Bernard, Christenson Jan T, Beghetti Maurice, Friedli Beat, Kalangos Afksendiyos
Clinic for Cardiovascular Surgery, University Hospital, Geneva, Switzerland.
Ann Thorac Surg. 2002 Jan;73(1):96-101. doi: 10.1016/s0003-4975(01)03325-2.
Complete correction of tetralogy of Fallot has good long-term results. Right ventricular outflow tract obstruction and pulmonary insufficiency occur which require reintervention. The present study evaluated the efficacy of reoperation following complete correction of tetralogy of Fallot, the sites of recurrences and impact of techniques used at first operation.
Between 1980 and 1999, 501 patients underwent complete correction of tetralogy of Fallot. Reoperation rate was 7.4%. Residual or recurrent right ventricular outflow tract stenosis was seen in 25 patients (68%), and 7 patients (19%) had severe pulmonary insufficiency. Age at redo was 9.1+/-6.4 years. Restenosis was most frequently observed (75%) at the bifurcation of the pulmonary artery. Extended 1-patch enlargement was used until 1989 and thereafter changed to a 2-patch technique.
Valvar-supravalvar 1-patch technique had a redo rate of 33.3%, compared with 4.3% for the 2-patch technique, p = 0.0264, with excellent freedom from reoperation rate. At reoperation right ventricular-pulmonary artery (RV-PA) conduits managed 29 patients and 3 had supravalvar patch enlargement. Hospital mortality was 5.4% (2 of 37). Twenty-five patients (68%) were in New York Heart Association functional class I to II at end of the follow-up, and none required further interventions.
Redo rate following complete correction of tetralogy of Fallot was 7.4%. Right ventricular outflow tract pathology was the dominant reason for reoperations (86%). At reoperation, RV-PA conduits was the most frequently used technique. Reoperation was efficient in reducing the RV-PA gradient, had low hospital and late mortality. A 2-patch valvar-supravalvar enlargement at first operation reduced the risk for redo in long-term follow-up.
法洛四联症的完全矫正术具有良好的长期效果。但会出现右心室流出道梗阻和肺动脉瓣关闭不全，需要再次干预。本研究评估了法洛四联症完全矫正术后再次手术的疗效、复发部位以及首次手术所采用技术的影响。
1980年至1999年间，501例患者接受了法洛四联症的完全矫正术。再次手术率为7.4%。25例患者（68%）出现残余或复发性右心室流出道狭窄，7例患者（19%）有严重的肺动脉瓣关闭不全。再次手术时的年龄为9.1±6.4岁。再狭窄最常见于肺动脉分叉处（75%）。1989年之前采用扩展单补片扩大术，之后改为双补片技术。
瓣膜-瓣上单补片技术的再次手术率为33.3%，而双补片技术为4.3%，p = 0.0264，再次手术率极低。再次手术时，右心室-肺动脉（RV-PA）管道治疗了29例患者，3例进行了瓣上补片扩大术。住院死亡率为5.4%（37例中有2例）。随访结束时，25例患者（68%）的心功能分级为纽约心脏协会I至II级，无一例需要进一步干预。
法洛四联症完全矫正术后的再次手术率为7.4%。右心室流出道病变是再次手术的主要原因（86%）。再次手术时，RV-PA管道是最常用的技术。再次手术能有效降低RV-PA压差，住院死亡率和远期死亡率较低。首次手术采用双补片瓣膜-瓣上扩大术可降低长期随访中的再次手术风险。
