右心室流出道单瓣肺动脉同种异体移植重建：中期结果。
Pulmonary homograft monocusp reconstruction of the right ventricular outflow tract: outcomes to the intermediate term.
机构信息
Childrens Hospital Los Angeles, Keck School of Medicine, University of Southern California, Division of Cardiothoracic Surgery, Los Angeles, California, USA.
出版信息
Ann Thorac Surg. 2010 Jul;90(1):42-9. doi: 10.1016/j.athoracsur.2010.03.045.
BACKGROUND
There is limited information on longer-term outcomes of pulmonary homograft monocusp (PHM) reconstruction of the right ventricular outflow tract (RVOT).
METHODS
A retrospective review of 131 consecutive patients undergoing RVOT reconstruction with PHM was completed.
RESULTS
Median age was 7.6 months (range, 1 day to 14 years) and weight was 7.3 kg (range, 2 to 65 kg). Most patients (108 of 131; 82%) underwent repair for Tetralogy. After PHM, median duration of mechanical ventilation was 1 day (range, 0 to 89) and hospital stay was 6.5 days (range, 2 to 137). Hospital mortality was 2% (3 of 131) with 1 patient undergoing early replacement of PHM. Echocardiogram at hospital discharge demonstrated peak RVOT gradient of 16 mm Hg (range, 4 to 64 mm Hg); and pulmonary insufficiency was absent/trivial in 40%, mild in 42%, moderate in 16%, and severe in 2%. Follow-up is completed in 91% of hospital survivors at a median of 5 years (range, 1 to 12). There were 5 late deaths, with an actuarial survival of 96% +/- 3.7%, 94% +/- 4.6%, and 89% +/- 9.2% at 1 year, 5 years, and 10 years, respectively. There were 24 reinterventions, including 10 pulmonary valve replacements. Median time to valve replacement was 1.9 years (range, 0.4 to 4.6). Actuarial freedom from pulmonary valve replacement was 97% +/- 3.0%, 90% +/- 6.1%, and 85% +/- 10.3% at 1 year, 5 years, and 10 years, respectively. Echocardiogram at last follow-up demonstrated no increase in RVOT gradient compared with hospital discharge (16 mm Hg), but there was significant increase in pulmonary insufficiency (mild 27%, moderate 39%, severe 34%).
CONCLUSIONS
Pulmonary homograft monocusp reconstruction is an alternative strategy for RVOT reconstruction and provides early but gradually diminishing protection against pulmonary insufficiency without a risk of stenosis. As expected, PHM function decreases over time as the RVOT grows and the homograft tissue undergoes structural deterioration.
背景
关于肺动脉同种带瓣管道单瓣（PHM）重建右心室流出道（RVOT）的长期结果，信息有限。
方法
对 131 例连续接受 PHM 行 RVOT 重建的患者进行回顾性分析。
结果
中位年龄为 7.6 个月（范围，1 天至 14 岁），体重为 7.3kg（范围，2 至 65kg）。大多数患者（131 例中的 108 例，82%）因四联症而行修复术。PHM 后，中位机械通气时间为 1 天（范围，0 至 89 天），住院时间为 6.5 天（范围，2 至 137 天）。住院死亡率为 2%（3/131），其中 1 例患者早期更换 PHM。出院时超声心动图显示 RVOT 峰值梯度为 16mmHg（范围，4 至 64mmHg）；肺动脉瓣关闭不全在 40%的患者中为无/轻度，42%的患者中为轻度，16%的患者中为中度，2%的患者中为重度。91%的住院幸存者完成了中位随访时间为 5 年（范围，1 至 12 年）的随访。有 5 例晚期死亡，累积生存率为 96% +/- 3.7%，1 年、5 年和 10 年分别为 94% +/- 4.6%和 89% +/- 9.2%。共行 24 次再介入治疗，其中 10 次行肺动脉瓣置换术。中位行换瓣时间为 1.9 年（范围，0.4 至 4.6 年）。1 年、5 年和 10 年时，无肺动脉瓣置换的累积生存率分别为 97% +/- 3.0%、90% +/- 6.1%和 85% +/- 10.3%。最后一次随访的超声心动图显示，与出院时相比，RVOT 梯度无明显增加（16mmHg），但肺动脉瓣关闭不全明显加重（轻度 27%，中度 39%，重度 34%）。
结论
肺动脉同种带瓣管道单瓣重建是 RVOT 重建的一种替代策略，可早期提供对肺动脉瓣关闭不全的保护，但不会增加狭窄的风险。正如预期的那样，随着 RVOT 的生长和同种带瓣管道组织的结构恶化，PHM 的功能会随时间逐渐下降。
Zotero 插件