Fujita Shuhei, Yamagishi Masaaki, Miyazaki Takako, Maeda Yoshinobu, Itatani Keiichi, Yamamoto Yusuke, Asada Satoshi, Hongu Hisayuki, Nakatsuji Hiroki, Yaku Hitoshi
Department of Pediatric Cardiovascular Surgery, Children's Medical Center, Kyoto Prefectural University of Medicine, Kyoto, Japan.
Division of Cardiovascular Surgery, Department of Surgery, Kyoto Prefectural University of Medicine, Kyoto, Japan.
Eur J Cardiothorac Surg. 2020 Dec 1;58(6):1274-1280. doi: 10.1093/ejcts/ezaa240.
In Japan, homograft and bovine jugular vein are available in very limited institutions for the reconstruction of the right ventricular outflow tract, and handmade expanded polytetrafluoroethylene (ePTFE)-valved conduits have been widely used instead. This study aimed to clarify the long-term outcomes and the durability of the ePTFE-valved conduits purely by narrowing down to those with large sizes to eliminate the influence of the body growth.
Between January 2002 and December 2015, patients who underwent right ventricular outflow tract reconstruction in 34 Japanese institutions using ePTFE-valved conduits with a diameter of ≥18 mm were included. All the valved conduits were made in the authors' institution and delivered to each participating institution.
Overall, 502 patients were included. Early mortality was 1.4% and not related to conduit failure. The overall survival rate was 98.2% at 5 years and 96.6% at 10 years. Freedom from conduit explantation was 99.5% at 5 years and 89.0% at 10 years. Three patients (0.13 per 100 patient-years) developed infective endocarditis of the conduit, and only 1 patient required conduit removal. Pulmonary insufficiency was mild or less in 480 (96%) patients, and conduit stenosis was mild or less in 436 (88%) patients at the latest follow-up.
By narrowing the analyses down to only ePTFE conduits with a large size, satisfactory long-term outcomes of these conduits with a fan-shaped valve and bulging sinuses were shown. These conduits would be among the optimal choices for right ventricular outflow tract reconstruction.
在日本，同种异体移植物和牛颈静脉仅在极少数机构可用于右心室流出道重建，因此手工制作的带瓣膨体聚四氟乙烯（ePTFE）管道被广泛应用。本研究旨在通过仅关注大尺寸管道来消除身体生长的影响，从而阐明带瓣ePTFE管道的长期疗效和耐用性。
纳入2002年1月至2015年12月期间在34家日本机构接受右心室流出道重建且使用直径≥18mm的带瓣ePTFE管道的患者。所有带瓣管道均由作者所在机构制作并分发给各参与机构。
共纳入502例患者。早期死亡率为1.4%，与管道故障无关。5年总生存率为98.2%，10年为96.6%。5年无管道取出率为99.5%，10年为89.0%。3例患者（每100患者年0.13例）发生管道感染性心内膜炎，仅1例患者需要取出管道。在最近一次随访时，480例（96%）患者的肺动脉瓣关闭不全为轻度或更轻，436例（88%）患者的管道狭窄为轻度或更轻。
通过仅分析大尺寸的ePTFE管道，显示出这些带有扇形瓣膜和膨出窦的管道具有令人满意的长期疗效。这些管道将是右心室流出道重建的最佳选择之一。
