Department of Cardiothoracic Surgery, Stanford University School of Medicine, Stanford, California.
Department of Pediatrics, Stanford University School of Medicine, Stanford, California.
Ann Thorac Surg. 2021 Nov;112(5):1501-1507. doi: 10.1016/j.athoracsur.2021.01.054. Epub 2021 Feb 16.
Appropriate conduit selection for right ventricle (RV)-to-pulmonary artery (PA) connection has been extensively studied, with older implantation age, pulmonary (vs aortic) homografts, and true sizing associated with increased longevity. Notably, patients with PA arborization abnormalities (ie, major aortopulmonary collateral arteries [MAPCAs]) are reported to require earlier and more frequent conduit interventions. We aim to understand the behavior of large-diameter aortic homografts in patients with MAPCAs, which are programmatically utilized at our institution.
This is a single-center retrospective cohort study including all children less than 12 years of age who underwent RV-PA connection using an aortic homograft greater than or equal to 16 mm diameter between 2002 and 2019, with a primary outcome of freedom from any RV-PA reintervention and a secondary outcome of freedom from surgical reintervention. Patients were grouped by absolute and indexed conduit sizes for further analysis.
A total of 336 conduits were followed for a median of 3.0 years; transcatheter (n = 30) or surgical (n = 35) reintervention was performed on 64 conduits. Estimated freedom from reintervention and surgical replacement was 84% and 90% at 5 years. Younger age and smaller absolute conduit size were associated with earlier reintervention, but conduit Z-score (median 3.5) was not associated with outcome.
The programmatic use of oversized aortic homograft RV-PA conduits in the surgical repair of MAPCAs provides a focused experience that demonstrates similar longevity to reported best alternatives. Secondarily, conduit oversizing may improve durability and enables an increased likelihood of nonoperative reintervention.
右心室（RV）-肺动脉（PA）连接的适当导管选择已经得到了广泛研究，较老的植入年龄、肺（与主动脉）同种移植物和真正的尺寸与寿命延长有关。值得注意的是，有肺动脉分支异常（即，主要主动脉肺动脉侧支动脉[MAPCAs]）的患者报告需要更早和更频繁的导管干预。我们旨在了解 MAPCAs 患者大直径主动脉同种移植物的行为，我们机构计划在这些患者中使用这种移植物。
这是一项单中心回顾性队列研究，包括 2002 年至 2019 年间所有接受 RV-PA 连接且使用直径大于或等于 16 毫米的主动脉同种移植物的年龄小于 12 岁的儿童，主要结局是无任何 RV-PA 再干预，次要结局是无手术再干预。患者根据绝对和指数导管大小分组进行进一步分析。
336 根导管的中位随访时间为 3.0 年；64 根导管进行了经导管（n=30）或手术（n=35）再干预。5 年时，无再干预和手术更换的估计生存率分别为 84%和 90%。年龄较小和绝对导管尺寸较小与较早的再干预相关，但导管 Z 评分（中位数 3.5）与结果无关。
在 MAPCAs 的手术修复中，有计划地使用过大直径的主动脉同种移植物 RV-PA 导管提供了一种集中的经验，表明与报告的最佳替代方案具有相似的寿命。其次，导管过大可能会提高耐用性，并增加非手术再干预的可能性。
