Gu Xinghua, Zhang Qiuwang, Sun Hourong, Fei Jianchun, Zhang Xiquan, Kutryk Michael J
Department of Cardiovascular Surgery, Qilu Hospital of Shandong University, 107 Wenhua West Road, Jinan 250012, China.
Division of Cardiology, Keenan Research Center for Biomedical Science at the Li Ka Shing Knowledge Institute, St. Michael's Hospital, University of Toronto, Toronto, ON, Canada.
Cardiol Res. 2017 Dec;8(6):286-292. doi: 10.14740/cr629e. Epub 2017 Dec 22.
Repeat surgery and the percutaneous approach (transcatheter closure (TCC)) have been used for the management of postoperative left-to-right shunts. In this study, we described our 15 years of experience in treating postoperative left-to-right shunts with these two approaches.
From February 2002 to February 2017, 50 patients with residual left-to-right shunts, following cardiac surgery, were treated using TCC or repeat surgery. Clinical examination, standard 12-lead electrocardiography, chest X-ray, and a transthoracic echocardiogram were performed before hospital discharge and at all follow-ups.
The closure rate was 100% in both groups and there was no procedure-related mortality. Patients with TCC had few complications. The procedure time and duration of hospital stay for TCC patients were 58.9 ± 27.7 min and 6.1 ± 0.8 days, respectively. Eleven out of 19 patients receiving reoperation suffered serious complications after surgery, e.g., bleeding and nosocomial infections. The operation time and duration of hospital stay for reoperation patients were 256.7 ± 60.5 min and 17.0 ± 4.0 days, respectively. No other serious complications were seen at all follow-up visits for both groups.
In conclusions, TCC is safe and effective for the management of postoperative left-to-right shunts, and is associated with few complications, which can be the favored closure strategy over repeat surgery for the management of postoperative left-to-right shunts.
再次手术和经皮介入方法（经导管封堵术（TCC））已用于术后左向右分流的治疗。在本研究中，我们描述了我们使用这两种方法治疗术后左向右分流的15年经验。
从2002年2月至2017年2月，50例心脏手术后存在残余左向右分流的患者接受了TCC或再次手术治疗。在出院前及所有随访时均进行临床检查、标准12导联心电图、胸部X线检查及经胸超声心动图检查。
两组封堵成功率均为100%，且无手术相关死亡。接受TCC治疗的患者并发症较少。TCC患者的手术时间和住院时间分别为58.9±27.7分钟和6.1±0.8天。19例接受再次手术的患者中有11例术后出现严重并发症，如出血和医院感染。再次手术患者的手术时间和住院时间分别为256.7±60.5分钟和17.0±4.0天。两组在所有随访中均未发现其他严重并发症。
总之，TCC治疗术后左向右分流安全有效，并发症少，是优于再次手术治疗术后左向右分流的首选封堵策略。
