UCSF Benioff Children's Hospital, Department of Surgery, University of California-San Francisco, San Francisco, California 94143, USA.
Ann Thorac Surg. 2011 Aug;92(2):666-71; discussion 671-2. doi: 10.1016/j.athoracsur.2011.04.024. Epub 2011 Jun 25.
The "sutureless" repair technique has improved outcomes for post-repair pulmonary vein (PV) stenosis. The purpose of this study is to determine the early outcomes of primary sutureless repair of pulmonary venoocclusive disease in infants with congenital PV stenosis-hypoplasia or PVs at high risk for progressive stenosis.
This is a retrospective review of infants who had primary sutureless repair of the PVs from October 2002 to April 2010.
Twenty-five infants had primary sutureless repair of the PVs. Eighteen infants had total anomalous pulmonary venous return; 14 with obstruction, 10 with heterotaxy syndrome, and 9 with univentricular anatomy. Seven infants had congenital PV stenosis. There were 24 perioperative survivors (96%; 95% confidence interval [CI], 75% to 99%) and 2 late deaths from extracardiac causes. Follow-up was available on 21 out of 22 survivors at a median duration of 34 months (range, 9 to 100 months). Persistence-recurrence of PV stenosis occurred in 3 veins (3%) of 2 infants (8%). On follow-up echocardiography, right ventricular systolic pressure was normal in 13 out of 14 infants with a biventricular heart and 60% of systemic blood pressure in 1 infant. Kaplan-Meier 1-year cumulative survival was 88% (95% CI, 66% to 96%). Kaplan-Meier cumulative disease-free survival was 96% (95% CI, 75% to 99%) at 30 days and 84% (95% CI, 58% to 95%) at 1 year. By Cox proportional hazards, age, univentricular anatomy, and atrial isomerism-heterotaxy syndrome were not associated with an increased risk of death or persistence-recurrence. One-year disease-free survival was lower in infants with prematurity (p=0.0055) and low birth weight (p=0.0011).
Primary sutureless repair is a feasible, safe, and relatively effective method of addressing congenital PV stenosis and (or) high-risk PVs, particularly in infants with single ventricle anatomy and (or) heterotaxy syndrome.
“无缝合”修复技术改善了肺静脉（PV）狭窄修复后的结果。本研究旨在确定原发性无缝合修复婴儿先天性 PV 狭窄-发育不良或 PV 狭窄高危患者的早期结果。
这是一项回顾性研究，纳入了 2002 年 10 月至 2010 年 4 月期间接受原发性无缝合修复 PV 的婴儿。
25 例婴儿接受了 PV 的原发性无缝合修复。18 例婴儿存在完全性肺静脉异位回流，其中 14 例存在梗阻，10 例患有异构综合征，9 例患有单心室解剖结构。7 例婴儿患有先天性 PV 狭窄。24 例患儿围手术期存活（96%；95%置信区间[CI]，75%至 99%），2 例晚期死于心脏外原因。22 例存活患儿中，21 例获得随访，中位随访时间为 34 个月（范围为 9 至 100 个月）。2 例患儿（8%）的 3 条静脉（3%）出现 PV 狭窄持续/复发。在随访的超声心动图中，14 例双心室心脏患儿中有 13 例右心室收缩压正常，1 例患儿为 60%的体循环血压。Kaplan-Meier 1 年累积生存率为 88%（95%CI，66%至 96%）。Kaplan-Meier 术后 30 天和 1 年的无疾病累积生存率分别为 96%（95%CI，75%至 99%）和 84%（95%CI，58%至 95%）。Cox 比例风险模型显示，年龄、单心室解剖结构和心房异构-异构综合征与死亡或持续/复发的风险增加无关。早产儿（p=0.0055）和低出生体重儿（p=0.0011）的 1 年无疾病生存率较低。
原发性无缝合修复是一种可行、安全且相对有效的治疗先天性 PV 狭窄和（或）高危 PV 的方法，特别是在单心室解剖结构和（或）异构综合征的婴儿中。
