Feins Eric N, Emani Sitaram M
Department of Cardiac Surgery, Boston Children's Hospital, Harvard Medical School, Boston, Massachusetts.
Department of Cardiac Surgery, Boston Children's Hospital, Harvard Medical School, Boston, Massachusetts.
Semin Thorac Cardiovasc Surg Pediatr Card Surg Annu. 2020;23:17-23. doi: 10.1053/j.pcsu.2020.02.002.
In congenital heart surgery, the surgeon must constantly consider how a palliative or corrective procedure could be impacted by the child's somatic growth. Within pediatric valve surgery, existing valve repair techniques lack growth-accommodating prostheses. Valve replacement options are fixed in size and unable to grow with the child, thus subjecting children to repeated valve reoperations. When creating a systemic-to-pulmonary artery shunt, replacing a branch pulmonary artery or conduit, creating an extracardiac Fontan pathway, or banding the pulmonary artery, the implant size must factor in both the child's current size and his or her anticipated growth. A variety of growth-accommodating technologies have been developed to fill this unmet need. Some devices have reached the clinical arena, while several are in preclinical development. The purpose of this review is to characterize the clinical need for growing device technology, and then review established and developing technologies for growth accommodation in congenital heart surgery.
在先天性心脏手术中，外科医生必须不断思考姑息性或矫正性手术会如何受到患儿身体生长的影响。在小儿瓣膜手术中，现有的瓣膜修复技术缺乏可适应生长的假体。瓣膜置换的选择尺寸固定，无法随患儿生长，因此患儿需要反复进行瓣膜再次手术。在创建体肺分流、置换分支肺动脉或管道、创建心外膜Fontan通路或结扎肺动脉时，植入物的尺寸必须同时考虑患儿当前的大小及其预期生长情况。已经开发了多种可适应生长的技术来满足这一未被满足的需求。一些设备已进入临床应用阶段，而有几种仍处于临床前研发阶段。本综述的目的是描述对可生长设备技术的临床需求，然后回顾先天性心脏手术中已有的和正在开发的可适应生长的技术。
