Department of Cardiovascular Surgery, Mayo Clinic, Rochester, MN, USA.
Division of Cardiology, Ann & Robert H. Lurie Children's Hospital of Chicago, USA.
World J Pediatr Congenit Heart Surg. 2021 Sep;12(5):628-634. doi: 10.1177/21501351211031242.
Although valve-sparing repair remains ideal for patients with tetralogy of Fallot, the durability of valve-sparing repair and which patients may have been better served with a transannular patch remain unclear.
Retrospective review was performed of tetralogy of Fallot operations at our institution from January 2008 to December 2018. Standard demographic data were collected, including echocardiographic parameters, operative details, and clinical outcomes. Statistical analysis was performed comparing the transannular patch and valve-sparing repair groups.
Sixty-seven patients underwent tetralogy of Fallot repair with a median age of 4.5 (3.2-6.0) months and weight of 5.8 (5.2, 6.7) kg. Seventeen (25%) patients underwent transannular patch repair and 50 (75%) patients underwent valve-sparing repair. There was no difference in age or weight between patients who underwent a transannular patch repair and those who underwent a valve-sparing repair. At last follow-up (median 42 months), there was a trend of a higher peak pulmonary valve/right ventricular outflow tract gradient ( = .06) in the valve-sparing group, but no difference in the pulmonary valve annulus -scores. Additionally, the pulmonary valve -scores in the valve-sparing group decreased from -2.3 ± 1.0 on predischarge echocardiogram of to -1.2 ± 1.6 on last follow-up, with the peak gradient on predischarge 23 (0-37) mm Hg remaining stable on last follow-up at 18 (0-29) mm Hg. There was one reoperation: pulmonary valve replacement six years after a transannular patch.
Obtaining a postrepair pulmonary valve -score of -2 yields satisfactory, stable valve-sparing repair with pulmonary valve growth, acceptable gradients, minimal regurgitation, and high freedom from reintervention during follow-up.
虽然对于法洛四联症患者来说，保留瓣膜修复仍然是理想的选择，但保留瓣膜修复的耐久性以及哪些患者可能通过跨瓣环补片修复获益更大仍不清楚。
对我院 2008 年 1 月至 2018 年 12 月期间进行的法洛四联症手术进行回顾性分析。收集了标准的人口统计学数据，包括超声心动图参数、手术细节和临床结果。比较了跨瓣环补片组和保留瓣膜修复组。
67 例患者接受法洛四联症修复术，中位年龄为 4.5（3.2-6.0）个月，体重为 5.8（5.2，6.7）kg。17 例（25%）患者行跨瓣环补片修复，50 例（75%）患者行保留瓣膜修复。跨瓣环补片修复组和保留瓣膜修复组患者的年龄和体重无差异。最后一次随访（中位时间 42 个月），保留瓣膜修复组的肺动脉瓣/右心室流出道峰值压差有增高趋势（ =.06），但肺动脉瓣环评分无差异。此外，保留瓣膜修复组的肺动脉瓣评分从出院前超声心动图的-2.3 ± 1.0 降至最后一次随访时的-1.2 ± 1.6，出院前峰值梯度为 23（0-37）mmHg，在最后一次随访时稳定在 18（0-29）mmHg。有 1 例再次手术：跨瓣环补片 6 年后行肺动脉瓣置换术。
获得修复后肺动脉瓣评分-2 分可使保留瓣膜修复获得满意、稳定的效果，伴有肺动脉瓣生长、可接受的梯度、最小的反流和在随访期间高免于再次干预的效果。
