Vitanova Keti, Cleuziou Julie, Pabst von Ohain Jelena, Burri Melchior, Eicken Andreas, Lange Rüdiger
Department of Cardiovascular Surgery, German Heart Centre Munich, Technische Universität München, Munich, Germany.
Department of Cardiovascular Surgery, German Heart Centre Munich, Technische Universität München, Munich, Germany.
Ann Thorac Surg. 2017 Feb;103(2):617-621. doi: 10.1016/j.athoracsur.2016.10.030. Epub 2016 Dec 23.
The development of recoarctation after the Norwood I procedure is a known complication in patients with hypoplastic left heart syndrome (HLHS).
We reviewed data on 194 consecutive patients with HLHS who underwent the Norwood I procedure between 2000 and 2015. All patients who survived until the second stage of the procedure were included. Recoarctation was defined by the need for intervention, either catheter based or surgical. The aim of our study was to determine if the patch material used for the initial arch reconstruction had an influence on the development of recoarctation.
The study population consisted of 145 patients. The patch material used for aortic arch reconstruction was either a homograft (n = 87), autologous pericardium (n = 23), equine pericardium (n = 28), or other material (n = 7). Recoarctation was documented in 27 patients (18%) at a median time of 4.3 months (range, 1 to 28 months) after completion of Norwood I. Freedom from recoarctation was 85% ± 4%, 86% ± 7%, and 30% ± 22% at 2 years for homograft, autologous pericardium, and equine pericardium, respectively. Thirty-six percent of patients with equine pericardium exhibited recoarctation, significantly more than homograft patch (p < 0.01) or autologous pericardium (p = 0.002). Treatment for recoarctation was percutaneous balloon angioplasty in 19 patients, stent implantation in 3, and operative enlargement of the aortic arch in 5. On univariate analysis, arch reconstruction with equine pericardium was the only risk factor for recoarctation (hazard ratio, 6.0; 95% confidence interval, 2.6-14; p < 0.01).
The patch material used for reconstruction of the aortic arch in HLHS influences the rate of recoarctation following the Norwood I procedure. Equine pericardium cannot be recommended.
在左心发育不全综合征（HLHS）患者中，诺伍德一期手术后再缩窄的发生是一种已知的并发症。
我们回顾了2000年至2015年间连续194例行诺伍德一期手术的HLHS患者的数据。纳入所有存活至手术第二阶段的患者。再缩窄定义为需要进行基于导管或手术的干预。我们研究的目的是确定用于初始主动脉弓重建的补片材料是否对再缩窄的发生有影响。
研究人群包括145例患者。用于主动脉弓重建的补片材料为同种异体移植物（n = 87）、自体心包（n = 23）、马心包（n = 28）或其他材料（n = 7）。在诺伍德一期手术完成后，27例患者（18%）记录到再缩窄，中位时间为4.3个月（范围1至28个月）。同种异体移植物、自体心包和马心包在2年时无再缩窄的比例分别为85%±4%、86%±7%和30%±22%。使用马心包的患者中有36%出现再缩窄，显著多于同种异体移植物补片（p < 0.01）或自体心包（p = 0.002）。19例患者接受经皮球囊血管成形术治疗再缩窄，3例植入支架，5例进行主动脉弓手术扩大。单因素分析显示，使用马心包进行主动脉弓重建是再缩窄的唯一危险因素（风险比，6.0；95%置信区间，2.6 - 14；p < 0.01）。
HLHS患者主动脉弓重建所使用的补片材料会影响诺伍德一期手术后再缩窄的发生率。不推荐使用马心包。
