Pediatric Cardiology, Children's Hospital of Pittsburgh of UPMC, Pittsburgh, Pa; Pediatric Cardiology, WVU Medicine Children's Hospital, Morgantown, WVa.
Pediatric Cardiology, Children's Hospital of Pittsburgh of UPMC, Pittsburgh, Pa.
J Thorac Cardiovasc Surg. 2018 May;155(5):2082-2091.e1. doi: 10.1016/j.jtcvs.2017.11.107. Epub 2018 Jan 31.
Our institution uses a valved polytetrafluoroethylene conduit as an alternative to homografts. The objective of this study was to investigate the performance of bicuspid valved polytetrafluoroethylene conduits used for right ventricular outflow tract reconstruction in children aged less than 2 years and to evaluate risk factors for earlier conduit explant.
We performed an Institutional Review Board-approved retrospective chart review of all patients aged less than 2 years who underwent surgical right ventricular outflow tract reconstruction with a bicuspid valved polytetrafluoroethylene conduit or homograft conduit from July 2004 to December 2014. The end points of the study were defined as conduit explant, conduit explant or reintervention, conduit stenosis, and conduit insufficiency.
Fifty-four patients underwent 65 right ventricular outflow tract reconstructions with a bicuspid valved polytetrafluoroethylene conduit (n = 39) or a homograft conduit (n = 26, 23 pulmonary, 3 aortic). The majority of diagnoses were truncus arteriosus (n = 28) and tetralogy of Fallot with pulmonary atresia (n = 19). Median age of patients at surgery was 134 (8-323) days and 128 (7-384) days in the PTFE and homograft groups, respectively. There was no difference in demographic data between the 2 groups. Time-to-event analysis demonstrated no difference in time to explant (P = .474) or time to explant or reintervention (P = .206) between the 2 conduit types. Younger age at surgery was the only independent risk factor for conduit explant (subdistribution hazard ratio 1.104 per 30 days younger, P < .001). There was no significant influence of conduit type on the development of moderate conduit stenosis (P = .931) or severe conduit insufficiency (P = .880). Larger conduit z score was protective for the development of moderate conduit stenosis (subdistribution hazard ratio, 0.46; P = .001).
Bicuspid valved polytetrafluoroethylene conduits are a satisfactory choice for right ventricular outflow tract reconstruction in patients aged less than 2 years. Their availability, low cost, and lack of potential sensitization make them an appealing alternative to homograft conduits.
本机构使用带瓣聚四氟乙烯管道作为同种移植物的替代物。本研究的目的是研究在 2 岁以下儿童中用于右心室流出道重建的双瓣带瓣聚四氟乙烯管道的性能，并评估早期管道取出的风险因素。
我们对 2004 年 7 月至 2014 年 12 月期间接受双瓣带瓣聚四氟乙烯管道或同种移植物管道行右心室流出道重建的所有 2 岁以下患者进行了机构审查委员会批准的回顾性图表审查。本研究的终点定义为管道取出、管道取出或再次干预、管道狭窄和管道功能不全。
54 例患者接受 65 例右心室流出道重建，其中 39 例使用双瓣带瓣聚四氟乙烯管道（n=39），26 例使用同种移植物管道（n=26，23 例为肺动脉，3 例为主动脉）。大多数诊断为动脉干（n=28）和法洛四联症伴肺动脉闭锁（n=19）。患者的中位手术年龄为 134（8-323）天和 128（7-384）天，分别为 PTFE 组和同种移植物组。两组患者的人口统计学数据无差异。时间事件分析表明，两种管道类型之间在管道取出时间（P=0.474）或管道取出或再次干预时间（P=0.206）方面无差异。手术年龄较小是管道取出的唯一独立危险因素（亚分布风险比每 30 天增加 1.104，P<0.001）。管道类型对中度管道狭窄（P=0.931）或严重管道功能不全（P=0.880）的发展无显著影响。较大的管道 z 评分可预防中度管道狭窄的发生（亚分布风险比，0.46；P=0.001）。
双瓣带瓣聚四氟乙烯管道是 2 岁以下患者右心室流出道重建的满意选择。它们的可用性、低成本和潜在致敏性使其成为同种移植物管道的一种有吸引力的替代品。
