Ambarsari Yuletta Adny, Purbojo Ariawan, Blumauer Robert, Glöckler Martin, Toka Okan, Cesnjevar Robert A, Rüffer André
Department of Pediatric Cardiac Surgery, University-Hospital Erlangen, Friedrich-Alexander-Universität Erlangen-Nürnberg (FAU), Erlangen, Germany.
Department of Pediatric Cardiology, University-Hospital Erlangen, Friedrich-Alexander-Universität Erlangen-Nürnberg (FAU), Erlangen, Germany.
Interact Cardiovasc Thorac Surg. 2018 Oct 1;27(4):591-597. doi: 10.1093/icvts/ivy100.
Systemic-to-pulmonary artery shunting remains an important palliative procedure in the staged management of complex congenital heart defects. The use of heparin-bonded polytetrafluoroethylene shunts (HBPSs) should enhance graft patency. This study aimed to review the single-centre experience using HBPS in the context of congenital cardiac surgery.
The records of 51 patients treated using HBPS between 2010 and 2016 were retrospectively reviewed. The median age and weight of the patients were 8 (range 3-83) days and 3.2 (range 1.8-5.7) kg, respectively. Selected shunt size was 3.5 mm in all patients. Fourteen (27.5%) patients were planned for future biventricular repair and 37 (72.5%) patients underwent univentricular pathway. Shunt modifications included central aortopulmonary shunts (n = 35; 68.6%) and modified Blalock-Taussig shunts (n = 16; 31.4%). Shunt patency and survival until estimated 2nd procedure were calculated using the Kaplan-Meier method.
Shunt patency was 90 ± 4% after a median duration of 133 (range 0-315) days. Early mortality (30 days) was 3.9% (n = 2). Another 3 patients died during their hospital stay. All the deceased patients had univentricular morphology, and the cause of death was not shunt related in all patients. Five patients developed subtotal HBPS thrombosis intraoperatively (n = 3), early postoperatively after 3 days (n = 1, 1.9%) or late after 41 days (n = 1, 1.9%). Treatment of those patients comprised right ventricular outflow tract opening (n = 2, 3.9%) or new shunting (n = 3, 5.9%). Elective shunt takedown was performed during corrective surgery (n = 10, 19.6%), bidirectional Glenn (n = 25, 49%) or shunt replacement (n = 5, 9.8%). At the end of follow-up, 1 (1.9%) patient had still an HBPS in situ. The survival rate until planned 2nd procedure was 87 ± 6% in univentricular patients and 100% in biventricular patients (P = 0.17).
The use of HBPS in the context of palliative heart surgery is safe and seems to warrant a long-term patency of systemic-to-pulmonary shunts. However, by acting on only 1 site of Virchow's triad, shunt thrombosis, occurring predominantly early, cannot be totally excluded.
体肺分流术仍是复杂先天性心脏病分期治疗中的一项重要姑息性手术。使用肝素结合聚四氟乙烯分流管（HBPS）应可提高移植物通畅率。本研究旨在回顾在先天性心脏手术中使用HBPS的单中心经验。
回顾性分析2010年至2016年间51例使用HBPS治疗患者的记录。患者的中位年龄和体重分别为8（范围3 - 83）天和3.2（范围1.8 - 5.7）kg。所有患者选用的分流管尺寸均为3.5mm。14例（27.5%）患者计划未来进行双心室修复，37例（72.5%）患者采用单心室路径。分流管改良包括中心性主动脉 - 肺动脉分流术（n = 35；68.6%）和改良布莱洛克 - 陶西格分流术（n = 16；31.4%）。使用Kaplan - Meier方法计算分流管通畅率及至预计第二次手术时的生存率。
中位随访133（范围0 - 315）天后，分流管通畅率为90±4%。早期死亡率（30天内）为3.9%（n = 2）。另有3例患者在住院期间死亡。所有死亡患者均为单心室形态，且所有患者的死亡原因均与分流管无关。5例患者术中发生HBPS部分血栓形成（n = 3），术后3天早期发生（n = 1，1.9%）或术后41天晚期发生（n = 1，1.9%）。这些患者的治疗包括右心室流出道开放（n = 2，3.9%）或重新分流（n = 3，5.9%）。在矫正手术期间进行择期分流管拆除（n = 10，19.6%）、双向格林手术（n = 25，49%）或分流管置换（n = 5，9.8%）。随访结束时，1例（1.9%）患者仍保留原位HBPS。单心室患者至计划第二次手术时的生存率为87±6%，双心室患者为100%（P = 0.17）。
在姑息性心脏手术中使用HBPS是安全的，似乎能保证体肺分流管的长期通畅。然而，由于仅作用于魏尔啸三联征的一个部位，分流管血栓形成主要发生在早期，无法完全排除。
