Louis Clauden, Swartz Michael F, Simon Bartholomew V, Cholette Jill M, Atallah-Yunes Nader, Wang Hongyue, Gensini Francisco, Alfieris George M
Department of Surgery, University of Rochester Medical Center, Rochester, New York.
Department of Surgery, University of Rochester Medical Center, Rochester, New York; Department of Pediatrics, University of Rochester Medical Center, Rochester, New York; Pediatric Cardiac Consortium of Upstate New York.
Semin Thorac Cardiovasc Surg. 2018 Summer;30(2):199-204. doi: 10.1053/j.semtcvs.2018.02.003. Epub 2018 Feb 8.
Repair of truncus arteriosus often requires early right ventricular outflow tract (RVOT) reoperation. Using a modified repair, the branch pulmonary arteries are left in situ, which may avoid earlier RVOT reoperation. We hypothesized that our modified repair for type I and II truncus arteriosus would extend the time to RVOT reoperation. Infants with truncus arteriosus were divided into 2 groups: (1) traditional technique where the branch pulmonary arteries are excised from the truncal root, or (2) modified repair where the branch pulmonary arteries are left in situ and septated from the truncal root. Regardless of the approach, a bioprosthetic conduit or homograft was used to establish right ventricular to pulmonary artery continuity. Follow-up pulmonary artery angiograms were used to assess for branch pulmonary artery stenosis. From 54 infants (modified repair: 33, traditional technique: 21), there were no significant differences in age at repair, gender, or type of truncus arteriosus. With 100% follow-up, use of the modified repair resulted in a lower rate of branch pulmonary artery stenosis, and greater freedom from surgical branch pulmonary arterioplasty. Five- and 10-year freedom from RVOT reoperation (5 years: modified-81.5% vs traditional-30.5%, P = 0.004; 10 years: modified-53.3% vs traditional-30.5%, P = 0.01) favored the modified repair. Cox regression analysis demonstrated that the modified repair was associated with an independently lower risk for RVOT reoperation (hazard ratio: 0.08, confidence interval: 0.01, 0.75, P = 0.02). Thus, maintaining the branch pulmonary artery architecture resulted in greater freedom from RVOT reoperation.
动脉干修复术通常需要早期进行右心室流出道（RVOT）再次手术。采用改良修复方法时，肺分支动脉保留在原位，这可能避免早期进行RVOT再次手术。我们推测，我们对I型和II型动脉干采用的改良修复方法将延长至RVOT再次手术的时间。患有动脉干的婴儿被分为两组：（1）传统技术组，即从动脉干根部切除肺分支动脉；（2）改良修复组，即肺分支动脉保留在原位并与动脉干根部分隔。无论采用哪种方法，均使用生物假体管道或同种异体移植物来建立右心室与肺动脉的连续性。随访时的肺动脉血管造影用于评估肺分支动脉狭窄情况。在54例婴儿中（改良修复组：33例，传统技术组：21例），修复时的年龄、性别或动脉干类型无显著差异。在100%的随访中，采用改良修复方法导致肺分支动脉狭窄率较低，且接受外科肺分支动脉成形术的自由度更高。5年和10年免于RVOT再次手术的情况（5年：改良修复组-81.5% vs传统技术组-30.5%，P = 0.004；10年：改良修复组-53.3% vs传统技术组-30.5%，P = 0.01）有利于改良修复方法。Cox回归分析表明，改良修复方法与RVOT再次手术的独立低风险相关（风险比：0.08，置信区间：0.01，0.75，P = 0.02）。因此，维持肺分支动脉结构可使免于RVOT再次手术的自由度更高。
