Choi Kwang Ho, Sung Si Chan, Kim Hyungtae, Lee Hyoung Doo, Kim Geena, Ko Hoon
Department of Thoracic and Cardiovascular Surgery, Research Institute for Convergence of Biomedical Science and Technology, Pusan National University Yangsan Hospital, Gyeongsangnam-do, Republic of Korea.
Department of Pediatric Cardiology, Pusan National University Yangsan Hospital, Yangsan-si, Gyeongsangnam-do, Republic of Korea.
J Card Surg. 2018 Jan;33(1):36-40. doi: 10.1111/jocs.13507. Epub 2018 Jan 4.
We report the results of a bicuspid expanded polytetrafluoroethylene (ePTFE) valved conduit used for right ventricular outflow tract reconstruction (RVOTR).
Between November 2005 and February 2009, 12 conduits were used for RVOTR. The mean age and weight of patients were 43.5 ± 46.4 months and 13.4 ± 8.6 kg. The main diagnosis was tetralogy of Fallot with pulmonary atresia in eight patients. The most common conduit size was 18 mm. The mean follow-up was 88.0 ± 35.9 months.
There were no operative and late mortalities. At discharge, the mean peak systolic pressure gradient across the RVOT was 14.1 ± 11.3 mmHg. There was no conduit valve regurgitation in nine patients. At the latest echocardiography (mean follow-up: 84.3 ± 35.5 months), the mean peak systolic pressure gradient across the RVOT was 59.7 ± 20.2 mmHg, and there was no conduit valve regurgitation in six patients. Freedom from conduit malfunction was 100% and 83.3%, at 1 and 8 years, respectively. Two conduits were explanted due to sternal compression and four from conduit malfunction. Freedom from explantation was 83.3% and 74.2% at 2 and 8 years, respectively.
ePTFE bicuspid valved conduit has good late function in terms of valve regurgitation, but the pressure gradient across the conduit increases with time, which is the main cause of conduit failure and explantation.
我们报告了用于右心室流出道重建（RVOTR）的双叶型膨体聚四氟乙烯（ePTFE）带瓣管道的结果。
2005年11月至2009年2月期间，12根管道用于RVOTR。患者的平均年龄和体重分别为43.5±46.4个月和13.4±8.6千克。主要诊断为8例法洛四联症合并肺动脉闭锁。最常用的管道尺寸为18毫米。平均随访时间为88.0±35.9个月。
无手术死亡和晚期死亡病例。出院时，右心室流出道的平均收缩压峰值梯度为14.1±11.3毫米汞柱。9例患者无管道瓣膜反流。在最近一次超声心动图检查时（平均随访：84.3±35.5个月），右心室流出道的平均收缩压峰值梯度为59.7±20.2毫米汞柱，6例患者无管道瓣膜反流。1年和8年时无管道故障的发生率分别为100%和83.3%。2根管道因胸骨压迫被取出，4根因管道故障被取出。2年和8年时无取出的发生率分别为83.3%和74.2%。
就瓣膜反流而言，ePTFE双叶带瓣管道后期功能良好，但管道两端的压力梯度随时间增加，这是管道故障和取出的主要原因。
