Matsuhisa Hironori, Oshima Yoshihiro, Higuma Tomonori, Matsushima Shunsuke, Hasegawa Shota, Wada Yuson, Matsuoka Michio, Tanaka Toshikatsu
Department of Cardiovascular Surgery, Kobe Children's Hospital, Kobe, Japan.
Department of Cardiology, Kobe Children's Hospital, Kobe, Japan.
Eur J Cardiothorac Surg. 2020 Aug 1;58(2):237-245. doi: 10.1093/ejcts/ezaa028.
We used computed tomographic angiography (CTA)-based surgical planning to clarify the anatomical indications of sutureless repair technique for total anomalous pulmonary venous connection. The mid-term impact of the current surgical strategies was evaluated.
One hundred twelve patients underwent repair for total anomalous pulmonary venous connection. The study period was divided into era 1 (1996-2010, n = 56) and era 2 (2011-2018, n = 56). Patients with single ventricular heart (SVH) were included. In era 2, the indications for primary sutureless repair and branch pulmonary vein incision were based on CTA findings.
For patients with biventricular heart, the 5-year survival was 69% and 97% in eras 1 and 2, respectively (P = 0.0024). For patients with SVH, the 5-year survival was 21% and 70% in eras 1 and 2, respectively (P = 0.0007). During the follow-up period, the evidence of post-repair pulmonary vein stenosis (PVS) was observed in 12 patients with biventricular heart [era 1, 8 patients (23%); era 2, 4 patients (13%)], and 14 patients with SVH [era 1, 6 patients (60%); era 2, 8 patients (36%)]. Using multivariable analysis, preoperative CTA was associated with improved survival in both biventricular heart and SVH and associated with post-repair PVS-free survival in SVH. Since 2011, 12 patients with post-repair PVS underwent multiple reintervention with 1 recorded death (5-year survival: 88%).
CTA-based surgical strategy for total anomalous pulmonary venous connection provided significant survival benefit. Although post-repair PVS could occur in era 2, aggressive reintervention appeared to be associated with improved survival and vein patency.
我们采用基于计算机断层血管造影（CTA）的手术规划来明确完全性肺静脉异位连接无缝合修复技术的解剖学指征。评估了当前手术策略的中期影响。
112例患者接受了完全性肺静脉异位连接修复术。研究期分为第1阶段（1996 - 2010年，n = 56）和第2阶段（2011 - 2018年，n = 56）。纳入单心室心脏（SVH）患者。在第2阶段，基于CTA结果确定一期无缝合修复和肺静脉分支切开的指征。
对于双心室心脏患者，第1阶段和第2阶段的5年生存率分别为69%和97%（P = 0.0024）。对于SVH患者，第1阶段和第2阶段的5年生存率分别为21%和70%（P = 0.0007）。在随访期间，12例双心室心脏患者[第1阶段，8例（23%）；第2阶段，4例（13%）]和14例SVH患者[第1阶段，6例（60%）；第2阶段，8例（36%）]出现修复后肺静脉狭窄（PVS）证据。采用多变量分析，术前CTA与双心室心脏和SVH患者生存率提高相关，且与SVH患者修复后无PVS生存率相关。自2011年以来，12例修复后PVS患者接受了多次再次干预，记录1例死亡（5年生存率：88%）。
基于CTA的完全性肺静脉异位连接手术策略提供了显著的生存获益。尽管在第2阶段可能发生修复后PVS，但积极的再次干预似乎与生存率提高和静脉通畅有关。
