Sughimoto Koichi, Miyaji Kagami, Oka Norihiko, Torii Shinzo, Kitamura Tadashi
Department of Cardiovascular Surgery, Kitasato University School of Medicine, 1-15-1, Kitasato, Minami-ward, Sagamihara, Japan.
Division of Pediatric Cardiothoracic Surgery, British Columbia Children's Hospital, 4480 Oak Street, Vancouver, Canada.
Gen Thorac Cardiovasc Surg. 2018 Jul;66(7):405-410. doi: 10.1007/s11748-018-0921-2. Epub 2018 Apr 26.
Although primary sutureless technique for total anomalous pulmonary venous drainage has been introduced to reduce postoperative pulmonary vein obstruction (PVO), controversy still exists about superiority of the procedure between the conventional repair and primary sutureless technique at the initial repair. In our unit, the conventional repair has been consistently used based on four important surgical policies: (1) mark incision lines between 2 chambers to gain anatomically natural alignment, (2) place precise stitches by "intima-to-intima" using monofilament suture, (3) adequate orifice size should be guaranteed in greater than expected mitral valve size, (4) do not hesitate to undertake a redo additional anastomosis by a different approach when an echocardiography shows the velocity more than 1.5 m/s. This study aims to evaluate mid-term outcome of the conventional repair for total anomalous pulmonary venous drainage.
Between 2004 and 2016, consecutive 15 patients who underwent the conventional repair without the primary sutureless technique were included in this study. Survival, Freedom from reoperation, and PVO were retrospectively reviewed.
Mean follow-up period was 4.6 ± 3.7 years. Except for one patient who died of uncontrollable pleural effusion, all other patients survived with 5-year survival rate of 93.3%. For the 14 survivors, there was no PVO, nor reoperation.
Following these policies, the mid-term outcome of the conventional total anomalous pulmonary venous drainage repair was excellent without the primary sutureless technique showing no obstruction. The conventional repair can be safely applied at the initial operation when the morphological condition allows for it.
尽管已引入用于完全性肺静脉异位引流的一期无缝合技术以减少术后肺静脉梗阻（PVO），但在初次修复时，该手术在传统修复和一期无缝合技术之间的优越性仍存在争议。在我们科室，基于四项重要的手术策略一直采用传统修复方法：（1）在两个腔室之间标记切口线以获得解剖学上的自然对齐；（2）使用单丝缝线通过“内膜对内膜”放置精确缝线；（3）对于大于预期二尖瓣大小的情况，应保证足够的开口大小；（4）当超声心动图显示流速超过1.5米/秒时，毫不犹豫地采用不同方法进行再次额外吻合。本研究旨在评估完全性肺静脉异位引流传统修复的中期结果。
2004年至2016年期间，连续15例接受传统修复而非一期无缝合技术的患者纳入本研究。对生存情况、免于再次手术情况和PVO进行回顾性分析。
平均随访期为4.6±3.7年。除1例死于无法控制的胸腔积液外，所有其他患者均存活，5年生存率为93.3%。对于14名幸存者，未发生PVO，也未进行再次手术。
遵循这些策略，完全性肺静脉异位引流传统修复的中期结果良好，无需一期无缝合技术且未出现梗阻。当形态学条件允许时，传统修复可在初次手术时安全应用。
