Corno Antonio F, Qanadli Salah D, Sekarski Nicole, Artemisia Simona, Hurni Michel, Tozzi Piergiorgio, von Segesser Ludwig K
Department of Cardiovascular Surgery, Centre Hospitalier Universitaire Vaudois, Lausanne, Switzerland.
Ann Thorac Surg. 2004 Oct;78(4):1382-8; discussion 1382-8. doi: 10.1016/j.athoracsur.2004.02.095.
This study was designed to evaluate the outcome of Contegra xenograft valved conduit (Contegra, Medtronic Inc, Minneapolis, MN).
From April 1999 to December 2003, 67 patients with a mean age of 16.1 +/-15.0 years (2 months to 53 years) and a mean weight of 39.7 +/- 27.1 kg (4 to 95 kg) were discharged after implantation of a Contegra conduit. The diagnosis contained the following: pulmonary valve replacement during Ross operation (n = 27), pulmonary valve regurgitation (n = 9), tetralogy of Fallot (n = 7), pulmonary atresia with ventricular septal defect (n = 7), double outlet right ventricle (n = 7), truncus arteriosus (n = 5), Taussig-Bing (n = 2), obstructed conduit (n = 2), and double discordance (n = 1). Conduit size was 14 mm in 2, 16 mm in 7, 18 mm in 12, 20 mm in 13, and 22 mm in 33 patients. Mean cardiopulmonary bypass was 155 +/- 48 min (65 to 337 min) and mean aortic cross clamping was 69 +/- 38 min (0 to 146 min). All patients underwent echocardiography, 23 of 67 (34%) patients had cardiac catheterization, and 23 of 67 (34%) patients had electrocardiograph-gated multislice computer tomography.
In a mean follow-up of 26.4 months (1 to 56 months) there was one late death (1 of 67 patients; 1.5% mortality) unrelated to the conduit. Five patients underwent reoperation; four were nonconduit-related and one was to replace a twisted conduit. Five patients underwent interventional cardiology; three were nonconduit-related and two were to stent a twisted or stenotic conduit. Echocardiography showed absent valve regurgitation in 30 of 67 (45%) patients, trivial in 21 of 67 (31%) patients, mild in 16 of 67 (24%) patients. The transconduit pressure gradient remained stable during follow-up, with peak pressure gradient 17 +/- 11 mm Hg and mean gradient 8 +/- 6 mm Hg. Internal diameters corresponded to 110% +/- 20% of the implanted diameter at level of proximal anastomosis, 112% +/- 18% at valve level, and 110% +/- 14% at distal anastomosis. Calcifications were not found, with the exception of a minimal (2.3 mm) parietal calcification.
The Contegra valved conduit provided excellent morphology and hemodynamics, and freedom from calcification in a medium-term follow-up.
本研究旨在评估Contegra异种移植带瓣管道（Contegra，美敦力公司，明尼阿波利斯，明尼苏达州）的使用结果。
从1999年4月至2003年12月，67例患者在植入Contegra管道后出院，这些患者的平均年龄为16.1±15.0岁（2个月至53岁），平均体重为39.7±27.1千克（4至95千克）。诊断包括以下情况：Ross手术期间的肺动脉瓣置换（n = 27）、肺动脉瓣反流（n = 9）、法洛四联症（n = 7）、室间隔缺损合并肺动脉闭锁（n = 7）、右心室双出口（n = 7）、永存动脉干（n = 5）、陶西格-宾畸形（n = 2）、管道梗阻（n = 2）和双心异构（n = 1）。2例患者使用的管道尺寸为14毫米，7例为16毫米，12例为18毫米，13例为20毫米，33例为22毫米。平均体外循环时间为155±48分钟（65至337分钟），平均主动脉阻断时间为69±38分钟（0至146分钟）。所有患者均接受了超声心动图检查，67例患者中有23例（34%）进行了心导管检查，67例患者中有23例（34%）进行了心电图门控多层计算机断层扫描。
平均随访26.4个月（1至56个月），有1例晚期死亡（67例患者中的1例；死亡率为1.5%），与管道无关。5例患者接受了再次手术；4例与管道无关，1例是为了更换扭曲的管道。5例患者接受了介入心脏病治疗；3例与管道无关，2例是为了对扭曲或狭窄的管道进行支架置入。超声心动图显示，67例患者中有30例（45%）无瓣膜反流，67例患者中有21例（31%）有微量反流，67例患者中有16例（24%）有轻度反流。随访期间跨管道压力梯度保持稳定，峰值压力梯度为17±11毫米汞柱，平均梯度为8±6毫米汞柱。在近端吻合口水平，内径相当于植入直径的110%±20%，在瓣膜水平为112%±18%，在远端吻合口水平为110%±14%。除了一处极小的（2.3毫米）壁钙化外，未发现钙化。
在中期随访中，Contegra带瓣管道提供了优异的形态和血流动力学，且无钙化。
