Department of Cardiovascular Surgery, West China Hospital of Sichuan University, Chengdu, China.
Department of Radiology, West China Hospital of Sichuan University, Chengdu, China.
Interact Cardiovasc Thorac Surg. 2022 Jan 18;34(2):307-314. doi: 10.1093/icvts/ivab238.
The aim of this study was to characterize the anatomy of aortopulmonary collateral (APC) arteries in tetralogy of Fallot and pulmonary stenosis and to determine whether APC density identified on preoperative multidetector cardiac computed tomography predicts in-hospital outcome.
The retrospective single-centre study includes consecutive 135 (2015-2019) patients who underwent one-stage repair. Preoperative multidetector cardiac computed tomography, echocardiography and clinical outcomes were reviewed. The cut-off value of indexed total distal APC cross-sectional area (APC-CSA) was identified by receiver operating characteristic curve. Logistic regression was used for predictors analysis.
The median age and body weight were 19.7 (10.1-89.7) months and 10 (8.3-18) kg. A total of 337 APCs were detected with only one demonstrating severe stenosis. There was a strong and significant correlation between mean APC diameter per patient and age (r = 0.70, P < 0.001). APCs were imaged but mainly received no interventions. In-hospital mortality was similar between patients with high (indexed APC-CSA ≥3.0 mm2/m2) and low (<3.0 mm2/m2) APC density (P = 0.642). Significantly greater patients with high indexed APC-CSA experienced the in-hospital composite outcome of death, arrest, renal/hepatic injury, lactic acidosis or extracorporeal membrane oxygenation (P = 0.007). High APC density was associated with greater dosing (P = 0.008) and longer (P = 0.01) use of inotropic support, prolonged pleural drainage (P = 0.013), longer ventilation (P = 0.042), intensive care unit (P = 0.014) and hospital (P = 0.027) duration. No reintervention and death occurred in the follow-up with the median duration of 24.4 (11-36.6) months. Multivariable analysis showed the Nakata index (P = 0.05) and high APC density (P = 0.02) independently predicted the composite outcome.
In tetralogy of Fallot and pulmonary stenosis, APCs are likely to be dilated bronchial arteries. Preoperative multidetector cardiac computed tomography-derived APC density was as important as Nakata index in predicting the occurrence of in-hospital composite outcome. The APC-CSA of 3.0 mm2/m2 maybe considered as a threshold for risk stratification.
本研究旨在描述法洛四联症合并肺动脉瓣狭窄患者体肺侧支（APC）动脉的解剖结构，并确定术前多排 CT 检测到的 APC 密度是否可预测住院结局。
本回顾性单中心研究纳入了 2015 年至 2019 年期间接受一期矫治术的 135 例（连续）患者。回顾性分析术前多排 CT、超声心动图和临床结局。通过受试者工作特征曲线确定指数化总远端 APC 横截面积（APC-CSA）的截断值。采用逻辑回归分析预测因素。
中位年龄和体质量分别为 19.7（10.1-89.7）个月和 10（8.3-18）kg。共检测到 337 条 APC，其中仅 1 条存在严重狭窄。每位患者的平均 APC 直径与年龄呈强正相关（r=0.70，P<0.001）。APC 可成像，但主要未予干预。高 APC 密度组（指数化 APC-CSA≥3.0mm2/m2）与低 APC 密度组（<3.0mm2/m2）的住院死亡率相似（P=0.642）。高指数 APC-CSA 组患者的住院复合结局（死亡、停搏、肾/肝功能损伤、乳酸性酸中毒或体外膜肺氧合）发生率显著更高（P=0.007）。高 APC 密度与更高剂量（P=0.008）和更长时间（P=0.01）的正性肌力支持、更长时间的胸腔引流（P=0.013）、更长时间的通气（P=0.042）、更长时间的 ICU 住院（P=0.014）和更长时间的住院（P=0.027）相关。随访期间未行再干预，也未发生死亡，中位随访时间为 24.4（11-36.6）个月。多变量分析显示，Nakata 指数（P=0.05）和高 APC 密度（P=0.02）独立预测了复合结局。
在法洛四联症合并肺动脉瓣狭窄中，APC 可能是扩张的支气管动脉。术前多排 CT 检测到的 APC 密度与 Nakata 指数一样，对预测住院期间复合结局均有重要价值。APC-CSA 为 3.0mm2/m2 可能是风险分层的一个阈值。
