Briceno-Medina Mario, Kumar T K Susheel, Sathanandam Shyam, Boston Umar, Perez Michael, Allen Jerry, Zurakowski David, Ilbawi Michel, Knott-Craig Christopher J
1Department of Pediatric Cardiology,Le Bonheur Children's Hospital and University of Tennessee Health Science Center,Memphis,Tennessee,United States of America.
2Department of Cardiothoracic Surgery,Le Bonheur Children's Hospital and University of Tennessee Health Science Center,Memphis,Tennessee,United States of America.
Cardiol Young. 2018 Jan;28(1):118-125. doi: 10.1017/S1047951117001688. Epub 2017 Aug 29.
To evaluate differences in interstage growth of pulmonary arteries between use of polytetrafluoroethylene and femoral vein homograft as Sano shunt during stage-I Norwood palliation.
A retrospective review of all patients who survived to the second stage following Norwood-Sano operation at two institutions was performed. Either polytetrafluoroethylene or the valved segment of femoral vein homograft was used for construction of the Sano shunt. The size of pulmonary arteries was compared at pre-Glenn catheterisation.
A total of 48 neonates with the diagnosis of hypoplastic left heart syndrome or its variants comprised the study population. Femoral vein homograft of 5-6 mm diameter was used in 14 and polytetrafluoroethylene graft of 5 mm was used in 34 patients. The two groups were comparable in terms of preoperative demographics and age at time of pre-Glenn catheterisation (3.9±0.7 versus 3.4±0.8 months, p=0.06). Patients who received femoral vein homograft demonstrated a significantly higher pre-Glenn Nakata index [264 (130-460) versus 165 (108-234) mm2/m2, p=0.004]. The individual branch pulmonary arteries were significantly larger in the femoral vein group (right, 7.8±3.6 versus 5.0±1.2, p=0.014; left, 7.2±2.1 versus 5.6±1.9, p=0.02). There were no differences in cardiac index, Qp:Qs, ventricular end-diastolic pressure or systemic oxygen saturations.
Utilisation of a valved segment of femoral vein homograft as right ventricle to pulmonary artery conduit during Norwood-Sano operation confers better interstage growth of the pulmonary arteries. Further studies are needed to evaluate the impact of femoral vein homograft on single ventricle function.
评估在一期诺伍德姑息手术中使用聚四氟乙烯和股静脉同种异体移植物作为桑诺分流时肺动脉在各阶段间生长的差异。
对两家机构接受诺伍德 - 桑诺手术后存活至第二阶段的所有患者进行回顾性研究。聚四氟乙烯或带瓣股静脉同种异体移植物用于构建桑诺分流。在格林分流导管插入术前比较肺动脉大小。
共有48例诊断为左心发育不全综合征或其变异型的新生儿纳入研究人群。14例使用直径5 - 6 mm的股静脉同种异体移植物，34例使用5 mm的聚四氟乙烯移植物。两组在术前人口统计学和格林分流导管插入术时的年龄方面具有可比性（3.9±0.7对3.4±0.8个月，p = 0.06）。接受股静脉同种异体移植物的患者在格林分流导管插入术前的中田指数显著更高[264（130 - 460）对165（108 - 234）mm²/m²，p = 0.004]。股静脉组的各分支肺动脉明显更大（右侧，7.8±3.6对5.0±1.2，p = 0.014；左侧，7.2±2.1对5.6±1.9，p = 0.02）。心脏指数、肺循环血流量与体循环血流量比值、心室舒张末期压力或全身氧饱和度无差异。
在诺伍德 - 桑诺手术中使用带瓣股静脉同种异体移植物作为右心室至肺动脉管道可使肺动脉在各阶段间生长更好。需要进一步研究以评估股静脉同种异体移植物对单心室功能的影响。
