Heart Centre for Children, The 8538Children's Hospital at Westmead, New South Wales, Australia.
64827School of Public Health, Curtin University, Perth, Australia.
World J Pediatr Congenit Heart Surg. 2021 Mar;12(2):220-229. doi: 10.1177/2150135120975769.
We sought to evaluate the outcomes following right ventricle to pulmonary artery (RV-PA) conduit placement in pediatric patients, excluding those with a RV-PA conduit for the Ross procedure which is associated with improved conduit durability, partly related to its orthotopic position.
Outcomes for 119 patients who underwent RV-PA conduit placement at a single institution from January 2004 to December 2016 were reviewed. Primary outcome measures were reintervention-free survival (RFS) and overall survival. Survival analyses were performed using the Kaplan-Meier method, and risk factors associated with reintervention were evaluated.
The median age at the time of conduit placement was 6 months (interquartile range, IQR: 1-14), and the median length of follow-up was 63 months (range: 0-156). During follow-up, 39 patients required conduit-related reintervention, while 6 patients died perioperatively with an overall survival of 90% at 10 years. Among the remaining 113 patients, the RFS at one, five, and ten years was 91% (84%-95%), 72% (60%-80%), and 33% (16%-50%), respectively. The median time to conduit replacement in the series was 43.5 months (IQR: 19.3-76.2). The use of a pulmonary homograft was associated with improved RFS ( = .03), and this was particularly pronounced in comparison with aortic homografts in neonates. Infection was the indication for replacement in only one patient.
The majority of the conduits placed during the neonatal period required conduit replacement before the age of five years. Endocarditis was not a common indication for replacement. In neonates and infants, we prefer pulmonary homografts for most indications.
本研究旨在评估除因 Ross 手术（因其原位性，部分与移植物耐久性改善相关）而置入右心室至肺动脉（RV-PA）管道的患儿外，其他接受 RV-PA 管道置入术的儿科患者的预后。
本研究回顾性分析了 2004 年 1 月至 2016 年 12 月期间在单中心接受 RV-PA 管道置入术的 119 例患者的临床资料。主要观察终点为免于再次干预的生存（RFS）和总体生存。采用 Kaplan-Meier 法进行生存分析，并评估与再次干预相关的风险因素。
RV-PA 管道置入时的中位年龄为 6 个月（四分位距[IQR]：1-14），中位随访时间为 63 个月（范围：0-156）。随访期间，39 例患者因管道相关问题需再次干预，6 例患者围手术期死亡，总体 10 年生存率为 90%。在其余 113 例患者中，RFS 在 1、5 和 10 年时分别为 91%（84%-95%）、72%（60%-80%）和 33%（16%-50%）。该系列研究中管道更换的中位时间为 43.5 个月（IQR：19.3-76.2）。使用肺动脉同种移植物与 RFS 改善相关（ =.03），且在新生儿中与主动脉同种移植物相比，这种相关性更为显著。仅有 1 例患者因感染而更换。
大多数在新生儿期置入的管道在 5 岁之前需要更换。感染不是更换的常见原因。对于新生儿和婴儿，我们大多数情况下首选肺动脉同种移植物。
