Lenoir Marien, Fouilloux Virginie, Desnous Beatrice, Rahmani Bilal, El Gueddari Nabila, Ovaert Caroline, Aries Edouard, El Louali Fedoua, Aldebert Philippe, Metras Dominique, Macé Loic
Department of Pediatric Cardiac Surgery, Timone, APHM, Marseille, France.
Department of Pediatric neurology, Timone, APHM, Marseille, France.
Cardiol Young. 2020 Nov;30(11):1679-1687. doi: 10.1017/S1047951120002553. Epub 2020 Aug 18.
Pulmonary atresia with ventricular septal defect and severe tetralogy of Fallot require a palliative procedure for pulmonary artery rehabilitation. For first-stage palliation, two main surgical options are still debated: right ventricle to pulmonary artery connection and modified Blalock-Taussig shunt. We compared the clinical outcomes of the two procedures.
From 1995 to 2018, 88 patients needed palliation (pulmonary atresia with ventricular septal defect n = 47; tetralogy of Fallot n = 41). Among these patients, 70 modified Blalock-Taussig shunt and 18 transannular path augmentation were performed before 6 months of age. Using a 1:1 propensity score match analysis, 20 patients were included in the analysis. The primary outcome was in-hospital mortality and pulmonary artery growth.
After matching, the pre-operative Nakata was smaller in transannular path augmentation 54 ± 24 mm2/m2 than modified Blalock-Taussig shunt 109 ± 31 mm2/m2 (p < 0.001). The age and weight were similar (p = 0.31 and p = 0.9, respectively). There was no difference in in-hospital mortality (p = 0.3). The Nakata index before biventricular repair and delta Nakata were smaller in modified Blalock-Taussig shunt group (206 ± 80 mm2/m2, 75 ± 103 mm2/m2) than transannular path augmentation (365 ± 170 mm2/m2, 214 ± 165 mm2/m2; p = 0.03; p < 0.001). Median time to biventricular repair was similar (p = 0.46). The rate of interstage reintervention was similar (p = 0.63).
The transannular path augmentation is better for the rehabilitation of the native pulmonary artery. Despite a smaller pulmonary artery, right ventricle to pulmonary artery connection is equivalent to modified Blalock-Taussig shunt for rate of biventricular repair and time to biventricular repair.
室间隔缺损合并肺动脉闭锁及严重法洛四联症需要进行姑息性手术以恢复肺动脉功能。对于一期姑息治疗，两种主要的手术选择仍存在争议：右心室至肺动脉连接术和改良布莱洛克-陶西格分流术。我们比较了这两种手术的临床结果。
1995年至2018年，88例患者需要进行姑息治疗（室间隔缺损合并肺动脉闭锁47例；法洛四联症41例）。在这些患者中，70例在6个月龄前进行了改良布莱洛克-陶西格分流术，18例进行了经环路径扩大术。采用1:1倾向评分匹配分析，20例患者纳入分析。主要结局指标为住院死亡率和肺动脉生长情况。
匹配后，经环路径扩大术组术前中田指数为54±24mm²/m²，低于改良布莱洛克-陶西格分流术组的109±31mm²/m²（p<0.001）。年龄和体重相似（分别为p=0.31和p=0.9）。住院死亡率无差异（p=0.3）。改良布莱洛克-陶西格分流术组双心室修复术前的中田指数和中田指数差值（206±80mm²/m²，75±103mm²/m²）低于经环路径扩大术组（365±170mm²/m²，214±165mm²/m²；p=0.03；p<0.001）。双心室修复的中位时间相似（p=0.46）。分期再次干预率相似（p=0.63）。
经环路径扩大术对天然肺动脉的恢复效果更好。尽管肺动脉较小，但右心室至肺动脉连接术在双心室修复率和双心室修复时间方面与改良布莱洛克-陶西格分流术相当。
