Department of Cardiothoracic Surgery, Erasmus University Medical Center, Rotterdam, The Netherlands.
Ann Thorac Surg. 2011 Jul;92(1):161-6. doi: 10.1016/j.athoracsur.2011.02.036. Epub 2011 May 18.
In tetralogy of Fallot (TOF) pulmonary regurgitation is a frequent complication after initial repair. The objective of the present study was to describe the long-term experience with the use of allograft conduits for right ventricular outflow tract (RVOT) reconstruction after correction of TOF in our institution.
Between 1987 and 2009, 133 allografts were implanted in 126 patients (mean age, 27.8 years). The mean time from initial TOF repair to allograft implantation was 20.8±8.8 years. Kaplan-Meier analyses were done for patient survival, freedom from allograft replacement and freedom from any cardiovascular event.
Hospital mortality was 1.5% (2 patients). Mean follow-up was 8.1 years. Ten other patients died during late follow-up, in 8 patients the cause was heart failure. Patient survival was 95% at 5 years, 91% at 10 years, and 80% at 15 years. Male sex, older patient age at the time of operation, and the use of preoperative diuretics were associated with increased risk of mortality during follow-up. Freedom from allograft replacement was 83% at 10 years and 70% at 15 years. Freedom from any valve-related event was 80% at 10 years and 67% at 15 years.
Right ventricular outflow tract reconstruction after previous TOF repair can be performed with low risk and a low reintervention rate. Allograft conduits function satisfactorily in the pulmonary position at longer-term follow-up. Functional status after allograft implantation in patients with a previous correction of TOF remains good. There is concern about the long-term survival and the occurrence of heart failure.
法洛四联症（TOF）患者初次修复后常发生肺动脉瓣关闭不全。本研究旨在描述本中心使用同种异体移植物重建 TOF 后右心室流出道（RVOT）的长期经验。
1987 年至 2009 年间，126 例患者（平均年龄 27.8 岁）共植入 133 个同种异体移植物。初次 TOF 修复至同种异体移植物植入的平均时间为 20.8±8.8 年。采用 Kaplan-Meier 分析法评估患者生存率、同种异体移植物无置换率和无任何心血管事件发生率。
院内死亡率为 1.5%（2 例）。平均随访 8.1 年。10 例患者在晚期随访中死亡，其中 8 例死因是心力衰竭。患者 5 年生存率为 95%，10 年生存率为 91%，15 年生存率为 80%。男性、手术时年龄较大和术前使用利尿剂与随访期间死亡率增加相关。10 年同种异体移植物无置换率为 83%，15 年为 70%。10 年无任何瓣膜相关事件发生率为 80%，15 年为 67%。
先前 TOF 修复后行 RVOT 重建的风险低，再次干预率低。同种异体移植物在肺动脉位置的长期随访中功能良好。先前行 TOF 矫正术的患者，同种异体移植物植入后的功能状态仍然良好。长期生存率和心力衰竭的发生令人担忧。
