肺动脉支架术后结果。

The outcome of pulmonary artery stents following surgical manipulation.

机构信息

Division of Pediatric Cardiogy, The University of Alabama at Birmingham, Birmingham, Alabama, USA.

出版信息

Catheter Cardiovasc Interv. 2011 Feb 15;77(3):390-4. doi: 10.1002/ccd.22694.

DOI:10.1002/ccd.22694

PMID:20549686

Abstract

BACKGROUND

Pulmonary artery (PA) stents are utilized to treat branch pulmonary stenosis (BPS). Often patients with PA stents undergo subsequent cardiac surgery for other indications, and the stents can be manipulated during the procedure.

OBJECTIVE

The purpose of this study was to evaluate the outcome of branch PA stenoses following surgical manipulation of previously implanted PA stents and to determine factors associated with future reintervention.

METHODS

Catheterization data, operative reports, and clinical summaries were reviewed on patients with PA stents placed between September 1989 and December 2006 undergoing subsequent cardiac surgery. Surgical manipulation was recorded as removed, trimmed, or longitudinally transected, and patched. Those that were not manipulated were defined as untouched.

RESULTS

459 patients had branch PA stents placed. About 54 patients, with 70 stents in branch PA's. subsequently had further cardiac surgery. The median age of stent placement was 7.5 (0.5-32.4) years with a median age of surgery of 12.7 (5.1-39.6) years. Surgical manipulation was performed in 23 (33%) PA's and 47 (66%) stents were untouched. Stent removal occurred in 11 (16%), with transecting longitudinally and patching in 5 (7%), and trimming in 7 (10%). Comparing the surgical manipulation and the untouched groups, there was no difference in median age of stent placement [7.2 (0.5-30.2) versus 7.6 (1.8-32.4) years, p=0.40], wt [21.0 (5.3-86.5) versus 24.7 (9.0-96.0) kg, p=0.42], or residual catheterization gradient across the stent [3 (0-59) versus 4 (0-50) mmHg, p=0.81]. Catheter reintervention (stent n=6 or balloon dilation n=14) on the previously stented PAs was similar between the surgically manipulated (median 7.5 years) and untouched groups (median 11.5 years) (p=0.31). In multivariate analysis, the factors associated with future catheter reintervention were having the stent transected longitudinally and patched (p=0.003) and a lower weight (p=0.006) at the time of stent placement.

CONCLUSIONS

Surgical stent manipulation is often performed in patients who have PA stents. Surgical manipulation does not alter the need for future reintervention and catheter re-intervention may be more likely when the stents are transected longitudinally and patched.

摘要

背景

肺动脉（PA）支架用于治疗分支肺动脉狭窄（BPS）。通常，PA 支架植入后的患者会因其他适应证而接受后续心脏手术，并且在手术过程中可以对支架进行操作。

目的

本研究旨在评估先前植入的 PA 支架在手术操作后的分支 PA 狭窄的结果，并确定与未来再介入相关的因素。

方法

回顾了 1989 年 9 月至 2006 年 12 月期间接受后续心脏手术的 PA 支架植入患者的导管插入术数据、手术报告和临床总结。将 PA 支架的手术操作记录为移除、修剪或纵向切开并用补片修补。未进行操作的定义为未触及。

结果

459 例患者接受了分支 PA 支架植入术。约 54 例（70 个支架）患者随后进行了进一步的心脏手术。支架植入的中位年龄为 7.5 岁（0.5-32.4 岁），手术的中位年龄为 12.7 岁（5.1-39.6 岁）。在 23 个 PA 中进行了手术操作，47 个（66%）支架未触及。11 个（16%）支架被移除，5 个（7%）支架被纵向切开并用补片修补，7 个（10%）支架被修剪。比较手术操作组和未触及组，支架植入的中位年龄[7.2（0.5-30.2）与 7.6（1.8-32.4）岁，p=0.40]、体重[21.0（5.3-86.5）与 24.7（9.0-96.0）kg，p=0.42]或支架内残余导管梯度[3（0-59）与 4（0-50）mmHg，p=0.81]无差异。先前支架植入的 PA 上的经导管再次介入（支架 n=6 或球囊扩张 n=14）在手术操作组（中位时间 7.5 年）和未触及组（中位时间 11.5 年）之间相似（p=0.31）。多因素分析显示，与未来经导管再次介入相关的因素包括支架纵向切开并用补片修补（p=0.003）和支架植入时体重较低（p=0.006）。