Cardiovascular and Thoracic Surgery Unit, Department of Surgery, King Chulalongkorn Memorial Hospital, Chulalongkorn University, Bangkok, Thailand.
Pediatric Cardiology Unit, Pediatric Department, King Chulalongkorn Memorial Hospital, Chulalongkorn University, Bangkok, Thailand.
Asian Cardiovasc Thorac Ann. 2021 Jul;29(6):483-489. doi: 10.1177/0218492320983449. Epub 2020 Dec 17.
Valved homografts are commonly used for right ventricular outflow tract reconstruction. However, despite good early results, they lack durability. This study was designed to compare single-center results of implantation of 3 types of right ventricular outflow tract conduit, in terms of patient survival, graft failure, reoperation, and risk factors for reoperation.
One hundred and forty-three pediatric patients who underwent right ventricular outflow tract conduit implantation between January 2006 and December 2018 were reviewed. We stratified conduits by aortic, pulmonic homograft, and Contegra; 74 aortic homografts, 61 pulmonic homografts, and 8 Contegra conduits were implanted. Median age at implantation was 3 years. The primary diagnosis was truncus arteriosus in 41.3%. We analyzed the role of sex, age, diagnosis, and graft size. Endpoints included freedom from graft failure, freedom from reoperation, and survival.
The survival rate was 83.2% at 10 years. Freedom from graft failure at 2, 5, and 10 years was 100%, 97.9%, and 63.4%, respectively. Freedom from reoperation was 85.8% for pulmonic homografts and 74.9% for aortic homografts at 10 years, and 100% for Contegra at 6 years. Multivariable analysis identified conduit diameter <18 mm as a risk factor for reoperation (hazard ratio: 3.16, 95% confidence interval: 1.38-7.23, = 0.007).
Homograft valves used for right ventricular outflow tract reconstruction provided excellent long-term durability and late survival. The only factor that adversely affected graft longevity was small graft size (diameter <18 mm). Reoperation for conduit failure was not significantly different among the groups.
带瓣同种移植物常用于右心室流出道重建。然而，尽管早期效果良好，但它们缺乏耐久性。本研究旨在比较三种右心室流出道移植物植入的单中心结果，包括患者生存率、移植物失败率、再次手术率和再次手术的危险因素。
回顾了 2006 年 1 月至 2018 年 12 月期间接受右心室流出道移植物植入术的 143 例儿科患者。我们按主动脉同种移植物、肺动脉同种移植物和康特格拉（Contegra）将移植物分层；植入 74 个主动脉同种移植物、61 个肺动脉同种移植物和 8 个康特格拉移植物。植入时的中位年龄为 3 岁。主要诊断为动脉干 41.3%。我们分析了性别、年龄、诊断和移植物大小的作用。终点包括移植物无失败、无再次手术和生存。
10 年生存率为 83.2%。2、5、10 年时移植物无失败率分别为 100%、97.9%和 63.4%。肺动脉同种移植物和主动脉同种移植物 10 年时无再次手术率分别为 85.8%和 74.9%，康特格拉移植物 6 年时为 100%。多变量分析确定移植物直径<18 mm 是再次手术的危险因素（风险比：3.16，95%置信区间：1.38-7.23，P=0.007）。
用于右心室流出道重建的同种移植物瓣膜提供了极好的长期耐久性和晚期生存率。唯一对移植物寿命产生不利影响的因素是移植物尺寸小（直径<18 mm）。各组之间移植物失败的再次手术率无显著差异。
