Bechtold Caroline, Purbojo Ariawan, Schwitulla Judith, Glöckler Martin, Toka Okan, Dittrich Sven, Cesnjevar Robert Anton, Rüffer André
Department of Pediatric Cardiac Surgery, Friedrich-Alexander-University Erlangen-Nuremberg (FAU), Erlangen, Germany.
Institute of Medical Informatics, Biometry and Epidemiology, Friedrich-Alexander-University Erlangen-Nuremberg (FAU) Universtiätsstrasse, Erlangen, Germany.
Thorac Cardiovasc Surg. 2015 Aug;63(5):373-9. doi: 10.1055/s-0034-1396532. Epub 2015 Jan 8.
The aim of this study was to analyze risk factors promoting development of recoarctation (Re-CoA) in neonates who survived aortic arch repair from an anterior approach.
Fifty consecutive neonates with biventricular morphology and ductal-dependent lower body perfusion who were discharged home following aortic arch repair with cardiopulmonary bypass between 2000 and 2012 were retrospectively reviewed. Arch anatomy was either interruption (n = 10) or hypoplasia with coarctation (n = 40). Aortic arch reconstruction was performed by using patch material (bovine pericardium, n = 30, homograft, n = 10, or glutaraldehyde-treated autologous pericardium, n = 7), and three patients underwent direct end-to-side anastomosis. Antegrade cerebral and continuous myocardial perfusion was performed in 39 and 21 patients, respectively. Kaplan-Meier freedom from Re-CoA was calculated. Morphologic and perioperative data indicating increased risk of Re-CoA by univariate analysis were included in multivariate Cox regression analysis.
Mean follow-up was 5.3 ± 4.1 years. Re-CoA occurred in 13 patients and was treated successfully by balloon dilatation (n = 6) or surgery (n = 7). Freedom from Re-CoA after 1 and 5 years was 83 ± 5 and 79 ± 6%, respectively. Two patients died early after surgical repair of Re-CoA. The use of autologous pericardium for aortic arch augmentation was the only independent risk factor for development of Re-CoA (hazard ratio: 4.3 [95% confidence interval: 1.2-16.1]; p = 0.028).
Re-CoA following neonatal aortic arch surgery can be treated by balloon dilatation or surgery, if adequate. In this study, the risk for development of Re-CoA was independently increased by the use of autologous pericardium during initial arch repair.
本研究旨在分析经前路主动脉弓修复术后存活的新生儿发生再缩窄（Re-CoA）的危险因素。
回顾性分析2000年至2012年间50例接受体外循环下主动脉弓修复术后出院的双心室形态且下半身依赖动脉导管供血的新生儿。主动脉弓解剖结构为中断型（n = 10）或缩窄合并发育不良型（n = 40）。采用补片材料（牛心包，n = 30；同种异体移植物，n = 10；或戊二醛处理的自体心包，n = 7）进行主动脉弓重建，3例患者行直接端侧吻合术。分别对39例和21例患者进行了顺行性脑灌注和持续心肌灌注。计算Kaplan-Meier无再缩窄生存率。单因素分析显示提示再缩窄风险增加的形态学和围手术期数据纳入多因素Cox回归分析。
平均随访时间为5.3±4.1年。13例患者发生再缩窄，分别通过球囊扩张术（n = 6）或手术（n = 7）成功治疗。1年和5年后无再缩窄生存率分别为83±5%和79±6%。2例患者在再缩窄手术修复后早期死亡。使用自体心包进行主动脉弓扩大是发生再缩窄的唯一独立危险因素（风险比：4.3[95%置信区间：1.2 - 16.1]；p = 0.028）。
新生儿主动脉弓手术后的再缩窄若情况合适可通过球囊扩张术或手术治疗。在本研究中，初次主动脉弓修复时使用自体心包会独立增加再缩窄发生的风险。
