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用于手工缝制三叶瓣带瓣管道的0.1毫米膨体聚四氟乙烯与自体心包的比较研究

0.1 mm ePTFE versus autologous pericardium for hand-sewn trileaflet valved conduit: a comparative study.

作者信息

Zhang Huifeng, Ye Ming, Chen Gang, Jia Bing

机构信息

Department of Cardiovascular Surgery, Children's Hospital of Fudan University, Shanghai, 201102, China.

Cardiovascular Center, Children's Hospital of Fudan University, 399 Wanyuan Road, Minhang District, Shanghai, China.

出版信息

J Artif Organs. 2019 Sep;22(3):207-213. doi: 10.1007/s10047-019-01107-5. Epub 2019 Jun 1.

Abstract

A hand-sewn trileaflet valved conduit is reportedly better than a bovine jugular graft. However, the comparative efficacy and safety between 0.1 mm ePTFE and autologous pericardium in this surgical procedure remained undetermined. This single-center cohort study included 46 patients aged 3-146 months who received implanted simplified hand-sewn trileaflet valved conduits: 31 patients (Group A) received 0.1 mm ePTFE valved conduits and 15 patients (Group B) received autologous pericardium valved conduits. Perioperative and follow-up outcomes up to 3 years after the surgeries were evaluated. No perioperative complications or early mortality were observed in either group, while one Group A patient aged 46 months died 6 months after surgery due to residual ventricular septal defect. No patients in Group A developed severe regurgitation or stenosis in valves of the conduits, but two moderate stenosis by echocardiography, and seven patients in group B were deemed to be conduit dysfunction (two stenosis, three stenosis plus regurgitation, and the remaining two regurgitation). No conduits failure was detected in group A, while two patients in group B (one for severe stenosis and the other one for severe regurgitation). After 6, 12, and 36 months, 95.2%, 88.9%, and 88.9% of Group A patients and 92.3%, 68.4%, and 42.7% of Group B patients were free from valved conduit dysfunction. After the same follow-up periods, all Group A patients had no conduit failure and 92.3%, 80.8%, and 80.8% of Group B patients were free from valved conduit failure. Within the 3-year follow-up period, 0.1 mm ePTFE novel simplified hand-sewn trileaflet valved conduits appear to be associated with a lower incidence of graft failure than autologous pericardium valved conduits.

摘要

据报道,手工缝制的三叶瓣带瓣管道优于牛颈静脉移植物。然而,在该手术中,0.1毫米的ePTFE与自体心包之间的比较疗效和安全性仍未确定。这项单中心队列研究纳入了46例年龄在3至146个月之间接受植入简化手工缝制三叶瓣带瓣管道的患者:31例患者(A组)接受0.1毫米ePTFE带瓣管道,15例患者(B组)接受自体心包带瓣管道。对手术至术后3年的围手术期和随访结果进行了评估。两组均未观察到围手术期并发症或早期死亡,而A组一名46个月大的患者术后6个月因残余室间隔缺损死亡。A组没有患者在管道瓣膜中出现严重反流或狭窄,但经超声心动图检查有两例中度狭窄,B组有7例患者被认为存在管道功能障碍(2例狭窄、3例狭窄加反流,其余2例反流)。A组未检测到管道失败,而B组有2例患者(1例因严重狭窄,另1例因严重反流)。6个月、12个月和36个月后,A组分别有95.2%、88.9%和88.9%的患者无带瓣管道功能障碍,B组分别有92.3%、68.4%和42.7%的患者无带瓣管道功能障碍。在相同的随访期后,A组所有患者均无管道失败,B组分别有92.3%、80.8%和80.8%的患者无带瓣管道失败。在3年随访期内,0.1毫米ePTFE新型简化手工缝制三叶瓣带瓣管道的移植物失败发生率似乎低于自体心包带瓣管道。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/8aac/6685934/e94a156be0a4/10047_2019_1107_Fig1_HTML.jpg

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