Ramírez-Marroquín Samuel, Curi-Curi Pedro José, Calderón-Colmenero Juan, García-Montes José Antonio, Cervantes-Salazar Jorge Luis
1 Department of Pediatric Cardiac and Congenital Heart Disease Surgery, Instituto Nacional de Cardiología Ignacio Chávez, Mexico City, Mexico.
2 Department of Pediatric Cardiology, Instituto Nacional de Cardiología Ignacio Chávez, Mexico City, Mexico.
World J Pediatr Congenit Heart Surg. 2017 Jan;8(1):69-76. doi: 10.1177/2150135116674439.
Surgical repair of common arterial trunk (CAT) by means of a homograft conduit has become a standard practice. We report our experience in the correction of this heart disease with a handmade bovine pericardial-valved woven Dacron conduit as an alternative procedure to homografts, with a focus on early, mid-term, and long-term results.
We designed a retrospective study that included 15 patients with a mean age of 1.5 years (range: three months to eight years), who underwent primary repair of simple CAT. Right ventricular outflow tract was reconstructed in all the cases with this handmade graft that was explanted at the time of its biological stenotic degeneration. A peeling procedure was performed at this time, in order to reconstruct the right ventricle-to-pulmonary artery continuity.
Overall mortality was 13.3% (one death at the early postoperative primary repair and the other at the mid-term postoperative peeling reoperation). Actuarial survival rate was 93.3%, 86.7%, and 86.7% at 5, 10, and 15 years, respectively. All of the 14 survivors developed stenosis of the handmade conduit at the mid-term period (8 ± 3 years), but after the peeling procedure, 13 survivors remain asymptomatic to date.
Primary repair of common arterial trunk using a handmade conduit can be performed with very low perioperative mortality and satisfactory mid-term and long-term results, which can be favorably compared with those reported with the use of homografts. When graft obstruction develops, peeling procedure is a good option because it does not affect the overall survival, although long-term outcomes warrant further follow-up.
使用同种异体移植物导管对共同动脉干（CAT）进行手术修复已成为一种标准做法。我们报告了使用手工制作的带牛心包瓣膜的编织涤纶导管矫正这种心脏病的经验，作为同种异体移植物的替代方法，重点关注早期、中期和长期结果。
我们设计了一项回顾性研究，纳入了15例平均年龄为1.5岁（范围：3个月至8岁）的患者，他们接受了单纯CAT的一期修复。所有病例均使用这种手工制作的移植物重建右心室流出道，该移植物在发生生物性狭窄退变时被取出。此时进行剥脱手术，以重建右心室与肺动脉的连续性。
总体死亡率为13.3%（1例在术后早期一期修复时死亡，另1例在术后中期剥脱再手术时死亡）。5年、10年和15年的精算生存率分别为93.3%、86.7%和86.7%。14名幸存者在中期（8±3年）均出现了手工制作导管的狭窄，但在剥脱手术后，13名幸存者至今仍无症状。
使用手工制作的导管对共同动脉干进行一期修复，围手术期死亡率非常低，中期和长期结果令人满意，与使用同种异体移植物报道的结果相比具有优势。当移植物发生梗阻时，剥脱手术是一个不错的选择，因为它不影响总体生存率，尽管长期结果仍需进一步随访。
