Okonta Kelechi E, Tamatey Martins
Division of Cardiothoracic Surgery, Department of Surgery, University College Hospital, Ibadan, Nigeria.
Interact Cardiovasc Thorac Surg. 2012 Nov;15(5):900-3. doi: 10.1093/icvts/ivs369. Epub 2012 Aug 22.
A best evidence topic in cardiac surgery was constructed according to a structured protocol. The question addressed was, 'Is double or single patch for sinus venous atrial septal defect repair the better option in prevention of postoperative venous obstruction?' Altogether seventy nine papers were found using the reported search; ten papers were identified that provided the best evidence to answer the question. The authors, journal, date, country of publication, patient group, study type, relevant outcomes and results of were tabulated. Three hundred and thirty four patients had single-patch with 7 (2.1%) having venous obstruction (venous obstruction; defined as obstruction at the atriocaval anastomosis and/or the right superior pulmonary vein) while 130 had double-patch with 3 (2.3%) having venous obstruction. However, when the three randomised studies were reviewed, 101 had single-patch and 67 had double-patch with 7 (7%) and 4 (6%) having venous obstruction respectively. Similarly, another randomised study that considered solely the two surgical options with eighteen patients who had single-patch repair as group A and 19 patients who had double-patch repair as group B with six patients in group A and 2 patients in group B having significant superior vena cava-right atrium pressure gradient of more than 6 mmHg. Nine patients in group A had a significant gradient causing turbulence across the right superior pulmonary vein at the level of the patch, whereas no patients in group B had turbulence across the pulmonary vein. The double-patch technique technically offered better results in terms of superior vena cava narrowing and gradient across the pulmonary vein without any increase in complications. However, in order to reduce postoperative venous obstruction while using the single-patch repair method, the adoption of the transcaval approach yielded excellent results, with unobstructed pulmonary and systemic venous flow as in 141 patients who had this method of repair only one patient had venous obstruction. In conclusion, the evidence was in support of the adoption of double-patch or the use of the transcaval repair technique when the single patch technique was used as a better option to avoid venous obstruction.
根据结构化方案构建了一个心脏外科的最佳证据主题。所探讨的问题是：“在预防术后静脉阻塞方面，双片修补或单片修补静脉窦型房间隔缺损哪种选择更好？”通过报告的检索共找到79篇论文；确定了10篇论文，它们提供了回答该问题的最佳证据。将作者、期刊、日期、出版国家、患者组、研究类型、相关结局和结果制成表格。334例患者采用单片修补，7例（2.1%）出现静脉阻塞（静脉阻塞定义为心房腔静脉吻合处和/或右上肺静脉处的阻塞）；130例采用双片修补，3例（2.3%）出现静脉阻塞。然而，在回顾3项随机研究时，101例采用单片修补，67例采用双片修补，分别有7例（7%）和4例（6%）出现静脉阻塞。同样，另一项仅考虑这两种手术方式的随机研究中，将18例接受单片修补的患者作为A组，19例接受双片修补的患者作为B组，A组6例患者和B组2例患者的上腔静脉-右心房压力梯度显著超过6 mmHg。A组9例患者在补片水平的右上肺静脉处出现显著梯度，导致血流紊乱，而B组无患者出现肺静脉血流紊乱。双片修补技术在技术上在上腔静脉狭窄和肺静脉梯度方面取得了更好的效果，且并发症没有增加。然而，为了在使用单片修补方法时减少术后静脉阻塞，采用经腔静脉入路取得了优异的效果，141例采用这种修补方法的患者肺和体循环静脉血流通畅，只有1例患者出现静脉阻塞。总之，证据支持采用双片修补或在使用单片技术时采用经腔静脉修补技术作为避免静脉阻塞的更好选择。
