Department of Thoracic Surgery, Leiden University Medical Center, Leiden, Netherlands.
Department of Pediatric Cardiology, Leiden University Medical Center, Leiden, Netherlands.
Interact Cardiovasc Thorac Surg. 2021 May 10;32(5):792-799. doi: 10.1093/icvts/ivab004.
We evaluated the outcomes of biventricular repair after initial hybrid palliation performed in small infants with various forms of left ventricle hypoplasia.
Between September 2010 and January 2020, a total of 27 patients had biventricular repair after hybrid palliation at a median age of 11 days. Indications for the hybrid approach included growth promotion of the left ventricle outflow tract and/or the aortic valve in 14 patients and that of the left ventricle in 13 patients. Seven reinterventions and 7 reoperations were performed during the interstage period. Significant growth of left ventricle parameters was noted during the median interstage period of 62 days. Sixteen subjects had aortic arch repair, ventricular septal defect closure and relief of subaortic stenosis; 5 patients had the Ross-Konno procedure; 5 patients underwent the Yasui procedure; and 1 patient had unbalanced atrioventricular septal defect and aortic arch repair.
Twenty-three patients (85.2%) are alive at a median follow-up of 3.3 years. Two and 3 patients died early and late after achieving biventricular circulation, respectively. There were 22 reinterventions and 15 reoperations after biventricular repair.
Hybrid palliation can stimulate left heart growth in some patients with left ventricle hypoplasia. More patients may eventually achieve biventricular circulation than was initially thought. Additional interventions and operations are foreseeable. Despite ventricular rehabilitation, some patients with borderline left ventricles may develop restrictive physiology.
我们评估了在患有各种左心室发育不全的小婴儿中进行初始杂交姑息治疗后行双心室修复的结果。
2010 年 9 月至 2020 年 1 月期间，共有 27 例患者在中位年龄 11 天接受了杂交姑息治疗后的双心室修复。杂交方法的适应证包括 14 例左心室流出道和（或）主动脉瓣以及 13 例左心室的生长促进。在中期 62 天的间隔期内，进行了 7 次再介入和 7 次再手术。在中位间隔期内，注意到左心室参数有明显的增长。16 例患者接受了主动脉弓修复、室间隔缺损关闭和解除主动脉瓣下狭窄；5 例患者行 Ross-Konno 手术；5 例患者行 Yasui 手术；1 例患者行房室间隔缺损和主动脉弓修复。
23 例患者（85.2%）在中位随访 3.3 年后存活。2 例和 3 例患者分别在实现双心室循环后早期和晚期死亡。双心室修复后有 22 次再介入和 15 次再手术。
杂交姑息治疗可刺激某些左心室发育不全患者的左心生长。与最初的想法相比，可能有更多的患者最终能够实现双心室循环。可预见会有更多的干预和手术。尽管进行了心室康复，但一些左心室临界患者可能会出现限制性生理。
