Kaur Resham, Bhurtel Dilli, Bielefeld Mark R, Morales J Mark, Durham Lucian A
1 Department of Pediatrics, Driscoll Children's Hospital, Corpus Christi, TX, USA.
2 Division of Pediatric Cardiovascular Surgery, Driscoll Children's Hospital, Corpus Christi, TX, USA.
World J Pediatr Congenit Heart Surg. 2018 Sep;9(5):509-512. doi: 10.1177/2150135118776616.
Many infants with congenital heart disease undergo palliative shunt procedures. In our center, cryopreserved saphenous vein and polytetrafluoroethylene (PTFE) are used as grafts to construct these shunts. In this retrospective review, we compare morbidity, mortality, and freedom from reoperation associated with the use of these graft materials. We conducted a retrospective study of 136 consecutive patients who were palliated with shunts between 2006 and 2015. A total of 136 patients were identified, 9 had incomplete data; thus, 127 patients were included: 69 saphenous and 58 PTFE. The cohorts were matched with respect to birth weight, gestational age, age and weight at time of surgery, and underlying cardiac condition. There were 15 (12%) deaths in the study cohort with no intraoperative mortality. Thrombosis was seen in 5.2% (2/38) of the saphenous modified Blalock-Taussig shunt (mBTS) group and 20.6% (14/68) of those with PTFE mBTS. There was no thrombosis in the central shunt group. Freedom from reoperation was 83% in the saphenous vein group and 81% in the PTFE group. There was no difference in overall morbidity or mortality, although thrombosis was significantly less in the saphenous vein group. Cryopreserved saphenous vein is a safe alternative, either as a mBTS or as a central shunt.
许多患有先天性心脏病的婴儿都要接受姑息性分流手术。在我们中心,使用冷冻保存的大隐静脉和聚四氟乙烯(PTFE)作为移植物来构建这些分流。在这项回顾性研究中,我们比较了使用这些移植物材料的发病率、死亡率和再次手术的无复发生存率。我们对2006年至2015年间连续接受分流姑息治疗的136例患者进行了回顾性研究。共确定了136例患者,其中9例数据不完整;因此,纳入了127例患者:69例使用大隐静脉,58例使用PTFE。两组在出生体重、胎龄、手术时的年龄和体重以及潜在心脏状况方面进行了匹配。研究队列中有15例(12%)死亡,无术中死亡。在大隐静脉改良布莱洛克-陶西格分流术(mBTS)组中,5.2%(2/38)出现血栓形成,在PTFE mBTS组中,20.6%(14/68)出现血栓形成。中心分流组未出现血栓形成。大隐静脉组再次手术的无复发生存率为83%,PTFE组为81%。总体发病率或死亡率无差异,尽管大隐静脉组的血栓形成明显较少。冷冻保存的大隐静脉是一种安全的选择,可用于mBTS或中心分流。