Seese Laura M, Turbendian Harma K, Castrillon Carlos E Diaz, Morell Victor O
Division of Cardiac Surgery, University of Pittsburgh Medical Center, Pittsburgh, PA, USA.
Division of Pediatric Cardiothoracic Surgery, University of Pittsburgh Medical Center, The Children's Hospital of Pittsburgh, Pittsburgh, PA, USA.
World J Pediatr Congenit Heart Surg. 2020 Mar;11(2):141-147. doi: 10.1177/2150135119888141.
Despite significant improvement in outcomes with truncus arteriosus (TA) repair, right ventricular outflow tract (RVOT) reconstruction with a right ventricular to pulmonary artery (RV-to-PA) conduit remains a source of long-term reintervention and reoperation. This study evaluated our experience with reintervention in homograft and polytetrafluoroethylene (PTFE) RV-to-PA conduits in neonates.
Primary TA repairs from 2004 to 2016 at a single institution were included. Stratification was based on RVOT reconstruction with PTFE or homograft conduit. Primary outcome was operative conduit replacement. Secondary outcomes included the rates and types of catheter-based conduit interventions.
Twenty-eight patients underwent primary TA repair and 89.3% (n = 25) of them had RVOT reconstruction with a homograft (28.0%, n = 7) or PTFE (72.0%, n = 18) conduit. Rates of reoperation for conduit replacement and catheter-based interventions were similar between those with PTFE and homograft conduits (85.7% vs 72.2%, = .49 and 57.1% vs 83.3%, = .11, respectively). Additionally, the median time to conduit replacement and catheter-based conduit interventions were comparable. In multivariable analysis, conduit size, but not conduit type, was a predictor of conduit revision (hazard ratio: 1.66, 95% confidence interval: 1.11-2.49, = .02). At five-year and ten-year follow-up, patients with PTFE conduits had better survival than those with homograft conduits (100.0% vs 71.4%, = .02); however, no mortalities were associated with conduit reoperations or catheter-based reinterventions.
Polytetrafluoroethylene and homograft RVOT reconstruction in neonatal TA repair demonstrate similar durability as defined by reoperation and reintervention rates. The validation of the durability of PTFE conduits in neonatal TA repair requires confirmatory studies in larger cohorts.
尽管动脉干（TA）修复的预后有了显著改善，但使用右心室至肺动脉（RV-to-PA）管道进行右心室流出道（RVOT）重建仍是长期再次干预和再次手术的一个原因。本研究评估了我们在新生儿同种异体移植物和聚四氟乙烯（PTFE）RV-to-PA管道再次干预方面的经验。
纳入2004年至2016年在单一机构进行的原发性TA修复病例。根据使用PTFE或同种异体移植物管道进行RVOT重建进行分层。主要结局是手术更换管道。次要结局包括基于导管的管道干预的发生率和类型。
28例患者接受了原发性TA修复，其中89.3%（n = 25）的患者使用同种异体移植物（28.0%，n = 7）或PTFE（72.0%，n = 18）管道进行了RVOT重建。PTFE管道组和同种异体移植物管道组之间的管道更换再次手术率和基于导管的干预率相似（分别为85.7%对72.2%，P = 0.49；57.1%对83.3%，P = 0.11）。此外，管道更换和基于导管的管道干预的中位时间相当。在多变量分析中，管道尺寸而非管道类型是管道翻修的预测因素（风险比：1.66，95%置信区间：1.11 - 2.49，P = 0.02）。在五年和十年随访时，使用PTFE管道的患者比使用同种异体移植物管道的患者有更好的生存率（100.0%对71.4%，P = 0.02）；然而，没有死亡与管道再次手术或基于导管的再次干预相关。
在新生儿TA修复中，聚四氟乙烯和同种异体移植物RVOT重建在再次手术和再次干预率方面显示出相似的耐久性。PTFE管道在新生儿TA修复中耐久性的验证需要在更大队列中的验证性研究。
