Pediatric Cardiac Surgery Center, National Center for Cardiovascular Disease and Fuwai Hospital, Chinese Academy of Medical Sciences, Peking Union Medical College, Beijing, China.
Interact Cardiovasc Thorac Surg. 2020 Nov 1;31(5):674-679. doi: 10.1093/icvts/ivaa145.
The present study evaluated the results of the modified réparation à l'étage ventriculaire (REV) based on the individual anatomical and pathological findings of the patients with an anomalous ventriculo-arterial connection with ventricular septal defect (VSD) and left ventricular outflow tract obstruction.
We reviewed a series of 24 patients who underwent modified REV between 2005 and 2019. Surgical indications included ventricles and atrioventricular valves suitable for biventricular repair, severe left ventricular outflow tract obstruction (peak gradient >30 mmHg), unrestrictive subaortic VSD and coronary arteries not suitable for reimplantation.
The mean follow-up time was 7.0 ± 4.2 years (range 0.5-14.1 years). Kaplan-Meier analyses showed that overall survival was 100% and freedom from any reoperation was 93.3% ± 6.4%. Longitudinal analyses of the available postoperative echocardiographic data showed that the left ventricular outflow tract peak gradient was less than 10 mmHg in all patients (15/15) and the left ventricular ejection fraction was more than 50% in 93.3% of patients (14/15). The right ventricular outflow tract peak gradient was less than 40 mmHg in 73.3% of patients (11/15).
The REV remains an option for selected patients despite the increasing use in recent years of the Nikaidoh procedure and its modifications. The surgical strategy needs to be determined by the specific anatomical and pathological findings of the patient. The modified REV had excellent long-term survival and freedom from reoperation for the treatment of anomalous ventriculo-arterial connection with VSD and left ventricular outflow tract obstruction. The long-term performance of the reconstructed left ventricular outflow tract and right ventricular outflow tract is satisfactory.
本研究根据伴有室间隔缺损（VSD）和左心室流出道梗阻的异常房室连接患者的个体解剖和病理发现，评估改良 réparation à l'étage ventriculaire（REV）的结果。
我们回顾了 2005 年至 2019 年间接受改良 REV 的 24 例患者的系列病例。手术适应证包括适合双心室修复的心室和房室瓣、严重左心室流出道梗阻（峰值梯度>30mmHg）、无限制的亚主动脉 VSD 和不适合再植入的冠状动脉。
平均随访时间为 7.0±4.2 年（0.5-14.1 年）。Kaplan-Meier 分析显示，总生存率为 100%，无任何再次手术的生存率为 93.3%±6.4%。对可获得的术后超声心动图数据的纵向分析表明，所有患者的左心室流出道峰值梯度均小于 10mmHg（15/15），93.3%的患者（14/15）的左心室射血分数大于 50%。73.3%的患者（11/15）的右心室流出道峰值梯度小于 40mmHg。
尽管近年来 Nikaidoh 手术及其改良术式的应用越来越多，但 REV 仍然是某些患者的选择。手术策略需要根据患者的具体解剖和病理发现来确定。改良 REV 治疗伴有 VSD 和左心室流出道梗阻的异常房室连接具有优异的长期生存率和无再次手术的自由，重建的左心室流出道和右心室流出道的长期性能令人满意。
