Quandt Daniel, Ramchandani Bharat, Penford Gemma, Stickley John, Bhole Vinay, Mehta Chetan, Jones Timothy, Barron David James, Stumper Oliver
The Heart Unit, Birmingham Children's Hospital NHS Foundation Trust, Birmingham, UK.
Pediatric Heart Center, University Children's Hospital Zurich, Zurich, Switzerland.
Heart. 2017 Dec;103(24):1985-1991. doi: 10.1136/heartjnl-2016-310620. Epub 2017 Aug 16.
This study sets out to compare morbidity, mortality and reintervention rates after stenting of the right ventricular outflow tract (RVOT) versus modified Blalock-Taussig shunt (mBTS) for palliation in patients with tetralogy of Fallot (ToF)-type lesions.
Retrospective case review study evaluating 101 patients (64 males) with ToF lesions who underwent palliation with either mBTS (n=41) or RVOT stent (n=60) to augment pulmonary blood flow over a 10-year period. Procedure-related morbidity, mortality and reintervention rates were assessed and compared.
Admission rate to paediatric intensive care unit (PICU) was lower in the RVOT stent group (22% vs 100%; p<0.001). Thirty-day mortality in the RVOT stent group was (1/60 (1.7%)) compared with (2/41 (4.9%)) in the mBTS group (p=0.565). Mortality until surgical repair was comparable in both groups (5/60, 8.4%, including three non-cardiac death in the RVOT stent group vs 2/41, 4.9% (p=0.698)). Total hospital length of stay was shorter for the RVOT stent group (median 7 days vs 14 days; p<0.003). Time to surgical repair was shorter in the RVOT stent group (median 232 days, IQR 113-360) compared with the mBTS group (median 428 days, IQR 370-529; p<0.001) due to improved pulmonary arterial growth.
RVOT stenting in Fallot-type lesions can be accomplished safely, with lower PICU admission rate, a shorter hospital length of stay and shorter duration of palliation until complete repair compared with mBTS palliation.
本研究旨在比较法洛四联症（ToF）型病变患者经右心室流出道（RVOT）支架置入术与改良布莱洛克 - 陶西格分流术（mBTS）进行姑息治疗后的发病率、死亡率和再次干预率。
回顾性病例研究，评估了101例患有ToF病变的患者（64例男性），他们在10年期间接受了mBTS（n = 41）或RVOT支架置入术（n = 60）以增加肺血流量。评估并比较了与手术相关的发病率、死亡率和再次干预率。
RVOT支架组入住儿科重症监护病房（PICU）的比率较低（22%对100%；p<0.001）。RVOT支架组的30天死亡率为1/60（1.7%），而mBTS组为2/41（4.9%）（p = 0.565）。两组直至手术修复时的死亡率相当（5/60，8.4%，包括RVOT支架组的3例非心脏死亡，对比2/41，4.9%（p = 0.698））。RVOT支架组的总住院时间较短（中位数7天对14天；p<0.003）。由于肺动脉生长改善，RVOT支架组至手术修复的时间比mBTS组短（中位数232天，四分位间距113 - 360），而mBTS组为（中位数428天，四分位间距370 - 529；p<0.001）。
与mBTS姑息治疗相比，ToF型病变的RVOT支架置入术可以安全完成，PICU入住率更低，住院时间更短，直至完全修复的姑息治疗持续时间更短。
