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Ross 患者右心室流出道重建中使用聚四氟乙烯管道。

Right ventricular outflow tract reconstruction using a polytetrafluoroethylene conduit in Ross patients.

机构信息

Department of Heart Valve Surgery, E. Meshalkin National Medical Research Centre, Novosibirsk, Russian Federation.

出版信息

Eur J Cardiothorac Surg. 2018 Sep 1;54(3):427-433. doi: 10.1093/ejcts/ezy128.

Abstract

OBJECTIVES

The type of conduit used for right ventricular outflow tract (RVOT) reconstruction during the Ross procedure remains problematic because of the limited availability of pulmonary allografts and the unsatisfactory long-term results associated with the use of xenografts. Polytetrafluoroethylene (PTFE) conduits have been proposed as an alternative. This study evaluated the results of RVOT reconstruction using a PTFE conduit during the Ross procedure.

METHODS

Between 2007 and 2015, 28 patients underwent RVOT reconstruction using PTFE conduits. The mean age of the patients was 35.9 ± 18.1 (range 4-58) years. The total root replacement technique was used in all patients. The mean PTFE conduit size was 25.3 ± 2.3 mm.

RESULTS

The early mortality rate was 3.6% (1 patient). The mean follow-up duration was 48.5 ± 31.2 months; there were no late deaths. The transprosthetic gradients increased significantly over time. The conduit size was the only independent predictor of peak RVOT gradient progression (P = 0.02). None of the patients demonstrated significant RVOT regurgitation. One patient required an RVOT reoperation.

CONCLUSIONS

The PTFE conduit demonstrates acceptable haemodynamic results at the mid-term follow-up and could be considered as an alternative substitute for RVOT reconstruction during the Ross procedure.

摘要

目的

由于肺同种异体移植物的有限可用性以及使用异种移植物相关的不满意的长期结果,用于右心室流出道(RVOT)重建的导管类型仍然存在问题。聚四氟乙烯(PTFE)导管已被提议作为替代物。本研究评估了在 Ross 手术中使用 PTFE 导管进行 RVOT 重建的结果。

方法

在 2007 年至 2015 年间,28 例患者接受了 PTFE 导管的 RVOT 重建。患者的平均年龄为 35.9±18.1(范围 4-58)岁。所有患者均采用全根替换技术。PTFE 导管的平均尺寸为 25.3±2.3mm。

结果

早期死亡率为 3.6%(1 例)。平均随访时间为 48.5±31.2 个月;无晚期死亡。跨瓣梯度随时间显著增加。导管尺寸是 RVOT 峰梯度进展的唯一独立预测因素(P=0.02)。没有患者出现明显的 RVOT 反流。1 例患者需要 RVOT 再次手术。

结论

PTFE 导管在中期随访中表现出可接受的血液动力学结果,可被视为 Ross 手术中 RVOT 重建的替代替代物。

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