Berdat Pascal A, Pfammatter Jean-Pierre, Pavlovic Mladen, Carrel Thierry
Department of Cardiovascular Surgery, University Hospital, Bern, Switzerland.
Heart Surg Forum. 2003;6(5):358-61.
Many different mechanical vascular anastomotic devices have been developed recently, mostly rigid stenting mechanisms applicable only in coronary artery bypass grafting surgery. U-Clips, however, allow the precise construction of any vascular interrupted anastomosis, preserving pulsatility and perhaps growth potential.
We report the first use worldwide of U-Clips for congenital cardiac surgery in 10 pediatric patients (mean age, 2.3 +/- 1.7 years). The operations took place between July 2001 and July 2002 for coarctation repair (3 patients), Glenn shunt (5 patients), Blalock-Taussig shunt (1 patient), and arterial switch (1 patient).
Device handling, primary hemostasis, and patency were excellent, and no device-related complications occurred. Because of the learning curve, aortic cross-clamp times were significantly longer for the repair of coarctation with U-Clips than with the running-suture technique (21.7 +/- 2.3 minutes versus 14.4 +/- 2 minutes; P = .012). Postoperative recoveries were uneventful in all patients except for a baby with pulmonary atresia with intact ventricular septum, who died after 62 days. After a mean follow-up period of 11.9 +/- 4.4 months, echocardiographic controls of all anastomoses showed nonturbulent flow without any restriction.
The U-Clip device may be a useful adjunct in congenital cardiac surgery for facilitating the creation of interrupted vascular anastomoses. Further evaluation is warranted for determining the long-term benefits of these devices with respect to growth preservation and restenosis.
近年来已研发出多种不同的机械性血管吻合装置，其中大多数是仅适用于冠状动脉搭桥手术的刚性支架机制。然而，U型夹能够精确构建任何血管间断吻合，保留搏动性以及可能的生长潜能。
我们报告了全球首次在10例儿科患者（平均年龄2.3±1.7岁）的先天性心脏手术中使用U型夹。手术于2001年7月至2002年7月期间进行，包括缩窄修复（3例患者）、格林分流术（5例患者）、布-塔分流术（1例患者）和动脉调转术（1例患者）。
器械操作、初步止血和通畅情况均极佳，未发生与器械相关的并发症。由于存在学习曲线，使用U型夹进行缩窄修复时的主动脉阻断时间明显长于连续缝合技术（21.7±2.3分钟对14.4±2分钟；P = 0.012）。除一名室间隔完整的肺动脉闭锁婴儿在术后62天死亡外，所有患者术后恢复均顺利。平均随访11.9±4.4个月后，所有吻合口的超声心动图检查均显示无湍流且无任何狭窄。
U型夹装置可能是先天性心脏手术中用于促进间断血管吻合构建的有用辅助工具。有必要进行进一步评估，以确定这些装置在保留生长和再狭窄方面的长期益处。
