Division of Congenital Cardiovascular Surgery, University Children's Hospital, Zurich, Switzerland.
Ann Thorac Surg. 2011 Jan;91(1):195-302; discussion 202-3. doi: 10.1016/j.athoracsur.2010.07.058.
The aim of this study is to evaluate risk factors affecting survival of Contegra grafts used in the pulmonary position.
One hundred seventy Contegra implanted (2001 to 2007) in the pulmonary position for replacement after a prior repair (90), Ross procedure (29), tetralogy of Fallot and variants (22), truncus arteriosus (13), Rastelli procedure (8), and miscellaneous (8) were reviewed. Median age was 107 (0.1 to 894) months. Follow-up was 96% complete with a median duration of 65 (7 to 98) months.
There were 7 early and 6 late deaths (none Contegra related) with a survival of 92%±2% at 98 months. Thirty-four Contegra were replaced at a median duration of 43 (7 to 82) months. Eight of 28 balloon-dilated Contegra remain palliated at 49 (23 to 73) months. Multivariate analysis showed Contegra less than 16 mm (p<0.001; HR [hazard ratio] 0.07), high pulmonary pressure (p<0.001; HR 4), and prior operation era (p=0.006; HR 0.3) as independent risk factors for Contegra replacement. The freedom from replacement for Contegra less than 16 mm and 16 mm or greater were 48%±8% and 98%±2%; for presence and absence of high pulmonary pressure were 52%±11% and 88%±3% and for era 1 and 2 were 77%±5% and 88%±4% at 60 months, respectively. Twenty-three of 123 surviving Contegra have a mean Doppler gradient greater than 20 mm Hg. Contegra less than 16 mm, smaller age group, obstructive arborization, and era 1 were significantly associated with higher gradients. While 18 (15%) surviving Contegra have moderate or more regurgitation, 88 (72%) have no significant gradient or regurgitation.
Contegra grafts integrate well into the body. Larger Contegra show predictable function with a survival approaching homografts over medium term. Better case selection as one ascends the learning curve tends to improve survival. With easy availability and predictable quality, Contegra grafts continue to be a promising complement to homografts.
本研究旨在评估影响肺位 Contegra 移植物存活的相关风险因素。
对 170 例肺位植入的 Contegra 移植物（2001 年至 2007 年）进行了回顾性分析，这些移植物用于先前修复后的替换（90 例）、Ross 手术（29 例）、法洛四联症和变异型（22 例）、动脉干（13 例）、Rastelli 手术（8 例）和其他（8 例）。中位年龄为 107（0.1 至 894）个月。随访率为 96%，中位随访时间为 65（7 至 98）个月。
早期死亡 7 例，晚期死亡 6 例（均与 Contegra 无关），98 个月时存活率为 92%±2%。34 例 Contegra 在中位时间 43（7 至 82）个月时进行了替换。28 例经球囊扩张的 Contegra 中，8 例仍在姑息治疗，中位时间为 49（23 至 73）个月。多变量分析显示，移植物小于 16mm（p<0.001；风险比[HR]0.07）、肺动脉高压（p<0.001；HR4）和先前手术时代（p=0.006；HR0.3）是移植物替换的独立风险因素。小于 16mm 和大于等于 16mm 的 Contegra 移植物的无替换生存率分别为 48%±8%和 98%±2%；存在和不存在肺动脉高压的生存率分别为 52%±11%和 88%±3%；时代 1 和时代 2 的生存率分别为 77%±5%和 88%±4%，中位随访时间为 60 个月。123 例存活的 Contegra 中有 23 例存在平均多普勒梯度大于 20mmHg。移植物小于 16mm、年龄较小、阻塞性分支和时代 1 与更高的梯度显著相关。18（15%）例存活的 Contegra 有中度或更严重的反流，88（72%）例无明显梯度或反流。
Contegra 移植物与机体良好融合。较大的 Contegra 移植物在中期具有可预测的功能，存活率接近同种移植物。随着学习曲线的上升，更好的病例选择往往会提高存活率。Contegra 移植物易于获得且质量可预测，继续成为同种移植物的有前途的补充。
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