Raja Shahzad G, Atamanyuk Iryna, Kostolny Martin, Tsang Victor
Department of Paediatric Cardiothoracic Surgery, Great Ormond Street Hospital, London WC1N 3JH, UK.
Interact Cardiovasc Thorac Surg. 2010 Apr;10(4):620-3. doi: 10.1510/icvts.2009.227322. Epub 2010 Jan 6.
A best evidence topic in congenital cardiac surgery was written according to a structured protocol. The question addressed was: in hypoplastic left heart patients is Sano shunt compared with modified Blalock-Taussig (mBT) shunt associated with deleterious effects on ventricular performance? Sano shunt modification of Norwood procedure involves construction of a right ventricle to pulmonary artery (RV-PA) conduit as an alternative source of pulmonary blood flow. Compared with the mBT shunt, the RV-PA conduit provides a more stable haemodynamic state in the immediate postoperative period and is reported to be associated with lower interstage mortality. However, concerns regarding the impact of ventriculotomy on short- and long-term performance of single ventricle have been expressed. Altogether 101 papers were found using the reported search terms, from which seven represented the best evidence to answer the clinical question. The authors, journal, date and country of publication, patient group studied, study type, relevant outcomes and results of these papers are tabulated. None of the echocardiographic or clinical outcome studies showed poor ventricular performance after ventriculotomy of the systemic RV for construction of Sano shunt. A small autopsy study of 11 patients showed greater remodelling of the ventricular myocardial extracellular matrix in patients with RV-PA conduit with potential implications for poor ventricular performance. We conclude that the current available evidence, although weak, does not show any adverse effects of ventriculotomy on ventricular performance in patients with Sano shunt in the short- and medium-term. However, all the existing studies are limited by small numbers, non-randomised design and retrospective nature with failure of correlation of echocardiographic indices to clinical outcomes. It is expected that the Pediatric Heart Network randomised controlled trial will address this important issue.
一篇关于先天性心脏手术的最佳证据主题文章是按照结构化协议撰写的。所探讨的问题是：在左心发育不全的患者中，与改良布莱洛克 - 陶西格（mBT）分流术相比，桑诺分流术是否会对心室功能产生有害影响？桑诺分流术是诺伍德手术的一种改良，涉及构建右心室至肺动脉（RV-PA）导管作为肺血流的替代来源。与mBT分流术相比，RV-PA导管在术后即刻提供更稳定的血流动力学状态，并且据报道与较低的分期间死亡率相关。然而，有人对心室切开术对单心室短期和长期功能的影响表示担忧。使用报告的搜索词共找到101篇论文，其中7篇代表了回答该临床问题的最佳证据。这些论文的作者、期刊、发表日期和国家、研究的患者组、研究类型、相关结果和结果均列于表格中。没有一项超声心动图或临床结局研究表明，为构建桑诺分流术而对体循环右心室进行心室切开术后心室功能不佳。一项对11名患者的小型尸检研究表明，RV-PA导管患者的心室心肌细胞外基质重塑程度更高，这可能对心室功能不佳产生影响。我们得出结论，目前可得的证据虽然薄弱，但并未显示心室切开术在短期和中期对接受桑诺分流术患者的心室功能有任何不利影响。然而，所有现有研究都受到样本量小、非随机设计和回顾性性质的限制，并且超声心动图指标与临床结局缺乏相关性。预计儿科心脏网络随机对照试验将解决这一重要问题。
