Myers Patrick O, Emani Sitaram M, Baird Christopher W
Cardiac Surgery, Boston Children's Hospital and Harvard Medical School, Boston, MA, USA Cardiovascular Surgery, Geneva University Hospitals and Faculty of Medicine, Geneva, Switzerland
Cardiac Surgery, Boston Children's Hospital and Harvard Medical School, Boston, MA, USA.
Multimed Man Cardiothorac Surg. 2016 Jan 14;2016. doi: 10.1093/mmcts/mmv038. Print 2016.
Reinterventions for proximal conduit obstruction or on the pulmonary arteries are frequent after Sano-modified stage I Norwood palliation of hypoplastic left heart syndrome. We report our experience with a modified Sano stage I, in which the right ventricle-to-pulmonary artery (PA) conduit used is reinforced by external rings to avoid collapse, and the conduit is inserted into the right ventricle through a limited ventriculotomy and 'dunked' into the ventricular cavity. In our experience, this modification was associated with fewer reinterventions or complications with the proximal anastomosis (P = 0.046 and 0.004), improved PA pulse pressure (9.1 ± 4.1 vs 4.8 ± 3.8 mmHg in controls, P < 0.001) and Nakata index (213 ± 76 vs 134 ± 68 mm(2)/m(2) in controls, P < 0.0001), although overall survival to a median of 20 months was not significantly different from controls. Right ventricular function at stage II-bidirectional Glen was marginally better in patients with the modified Sano conduit, however not to a significant level. Further evaluation of late ventricular function is currently ongoing.
在对左心发育不全综合征进行Sano改良I期诺伍德姑息手术后，近端管道梗阻或肺动脉再干预很常见。我们报告了改良Sano I期手术的经验，其中使用的右心室至肺动脉（PA）管道通过外环加固以避免塌陷，并且通过有限的心室切开术将管道插入右心室并“浸入”心室腔。根据我们的经验，这种改良与近端吻合术的再干预或并发症较少相关（P = 0.046和0.004），肺动脉脉压得到改善（对照组为9.1±4.1 vs 4.8±3.8 mmHg，P <0.001）和中田指数（对照组为213±76 vs 134±68 mm²/m²，P <0.0001），尽管中位生存期20个月的总体生存率与对照组无显著差异。在改良Sano管道的患者中，II期双向格林手术时的右心室功能略好，但未达到显著水平。目前正在对晚期心室功能进行进一步评估。
