肺动脉环缩术治疗功能性单心室：分期 Fontan 时代更紧的环缩术的影响。

Pulmonary artery banding for functionally single ventricles: impact of tighter banding in staged Fontan era.

机构信息

Department of Cardiovascular Surgery, Kanagawa Children's Medical Center, Yokohama, Japan.

出版信息

Ann Thorac Surg. 2010 Jan;89(1):174-9. doi: 10.1016/j.athoracsur.2009.09.027.

DOI:10.1016/j.athoracsur.2009.09.027

PMID:20103229

Abstract

BACKGROUND

In this study, we assessed our surgical strategy, tighter pulmonary artery banding (PAB) during the neonatal period, as an initial step followed by early application of bidirectional cavopulmonary shunts (BCPS) in infancy, to treat functionally single ventricles with unobstructed pulmonary blood flow.

METHODS

On the basis of our surgical strategy, 68 consecutive patients underwent PAB and were divided into two groups, group 1 (January 1990 to June 2003; n = 30) and group 2 (July 2003 to August 2008; n = 38). The median age at PAB was 45 days in group 1 and 9 days in group 2. The circumference of the bands was significantly shorter in group 2 than in group 1, corresponding to the patient's weight in kg plus 19.0 +/- 0.6 mm in group 1 or 17.0 +/- 0.3 mm in group 2 (p = 0.003).

RESULTS

Cardiac catheterization before the right heart bypass operation showed that the pulmonary artery index (group 1, 322 +/- 29; group 2, 283 +/- 27 mm(2)/m(2); p = 0.01), pulmonary resistance index (group 1, 2.4 +/- 0.2; group 2, 1.9 +/- 0.1 U x m(2); p = 0.03), and ventricular end-diastolic volume (group 1, 212 +/- 19%; group 2, 166 +/- 9%; p = 0.04) were significantly different between the two groups. The rates for achievement of right heart bypass at 12 months (group 1, 19%; group 2, 81%; p < 0.01) and survival at 3 years (group 1, 70%; group 2, 87%; p = 0.04) were significantly higher in group 2 than in group 1.

CONCLUSIONS

Our present strategy could prevent volume overload and improve the achievement and survival rates of right heart bypass operations.

摘要

背景

在这项研究中，我们评估了我们的手术策略，即在新生儿期进行更紧的肺动脉环缩术（PAB），然后在婴儿期早期应用双向腔肺分流术（BCPS），以治疗功能单心室且肺血流量无阻塞。

方法

根据我们的手术策略，68 例连续患者接受了 PAB，并分为两组，第 1 组（1990 年 1 月至 2003 年 6 月；n = 30）和第 2 组（2003 年 7 月至 2008 年 8 月；n = 38）。第 1 组 PAB 的中位年龄为 45 天，第 2 组为 9 天。第 2 组的环缩带周长明显短于第 1 组，分别为患者体重（kg）加 19.0 ± 0.6mm（第 1 组）或 17.0 ± 0.3mm（第 2 组）（p = 0.003）。

结果

右心旁路术前心导管检查显示，肺动脉指数（第 1 组，322 ± 29；第 2 组，283 ± 27mm²/m²；p = 0.01）、肺动脉阻力指数（第 1 组，2.4 ± 0.2；第 2 组，1.9 ± 0.1U×m²；p = 0.03）和心室舒张末期容积（第 1 组，212 ± 19%；第 2 组，166 ± 9%；p = 0.04）两组间差异有统计学意义。12 个月时达到右心旁路的比率（第 1 组，19%；第 2 组，81%；p < 0.01）和 3 年时的存活率（第 1 组，70%；第 2 组，87%；p = 0.04）第 2 组明显高于第 1 组。