Buber Jonathan, Assenza Gabriele Egidy, Huang Alice, Valente Anne Marie, Emani Sitaram M, Gauvreau Kimberlee, Marshal Audrey C, McElhinney Doff B, Landzberg Michael J
Department of Cardiology, Boston Children's Hospital, Boston, MA, United States.
Department of Cardiology, Boston Children's Hospital, Boston, MA, United States.
Int J Cardiol. 2014 Aug 20;175(3):455-63. doi: 10.1016/j.ijcard.2014.06.023. Epub 2014 Jun 28.
Subpulmonary ventricular outflow conduits are utilized routinely to repair complex congenital cardiac abnormalities, but are limited by the inevitable degeneration and need for reintervention. Data on conduit durability and propensity to dysfunction in the adult population are limited.
The study included 288 consecutive patients ≥18 years of age who were evaluated between 1991 and 2010 after placement of a ≥18 mm conduit. Freedom from hemodynamic conduit dysfunction served as our primary outcome. Freedom from reintervention, overall mortality and heart transplantation were also evaluated.
Median age at conduit implant was 19 years and median follow-up duration was 13 years. Probabilities of survival without conduit dysfunction and reintervention at 5, 10 and 15 years were 87%, 63%, and 49%, and 95%, 81%, and 56%, respectively. Smaller conduit diameter (18-20mm) was associated with lower probability of survival without dysfunction in the entire study cohort, with prominent effects in patients in both the lowest and the highest age quartiles. Other parameters with similar associations were higher BMI, native anatomy of tetralogy of Fallot or truncus arteriosus, and active smoking.
Adult congenital heart disease patients with conduit diameter ≥18 mm had an approximately 50% chance of developing hemodynamic conduit dysfunction and undergoing conduit reintervention by 15 years of post-implant, and a 30% likelihood of undergoing conduit reoperation in the same time frame. The importance of these data is underscored by the increasing number of adults with congenital heart diseases seeking care and the recent advances in transcatheter valve replacement for dysfunctional conduits.
肺动脉下心室流出道管道常用于修复复杂先天性心脏畸形，但受到不可避免的退变以及需要再次干预的限制。关于该管道在成人患者中的耐久性和功能障碍倾向的数据有限。
该研究纳入了288例年龄≥18岁的连续患者，这些患者在1991年至2010年间接受了≥18mm管道植入术后接受评估。血流动力学管道功能障碍的无事件生存率作为主要结局。还评估了再次干预的无事件生存率、总死亡率和心脏移植情况。
管道植入时的中位年龄为19岁，中位随访时间为13年。5年、10年和15年无管道功能障碍和再次干预的生存概率分别为87%、63%和49%，以及95%、81%和56%。在整个研究队列中，较小的管道直径（18 - 20mm）与无功能障碍生存的较低概率相关，在年龄最低和最高四分位数的患者中影响显著。其他具有类似关联的参数包括较高的体重指数、法洛四联症或动脉干的原生解剖结构以及主动吸烟。
管道直径≥18mm的成人先天性心脏病患者在植入后15年时发生血流动力学管道功能障碍并接受管道再次干预的概率约为50%，在同一时间段内接受管道再次手术的可能性为30%。随着寻求治疗的先天性心脏病成人数量不断增加以及功能障碍管道经导管瓣膜置换术的最新进展，这些数据的重要性得到了凸显。
