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聚四氟乙烯瓣状管道的中期结果。

Midterm Outcomes for Polytetrafluoroethylene Valved Conduits.

机构信息

Department of Cardiothoracic Surgery, Children's Hospital of Fudan University, Shanghai, China.

Department of Cardiothoracic Surgery, Children's Hospital of Fudan University, Shanghai, China.

出版信息

Ann Thorac Surg. 2022 Nov;114(5):1778-1785. doi: 10.1016/j.athoracsur.2021.09.051. Epub 2021 Oct 27.

Abstract

BACKGROUND

Various conduits for right ventricular outflow tract reconstruction have been reported, but most of them are not available in China. The study investigators developed a simple handsewn valved conduit using expanded polytetrafluoroethylene (ePTFE). This study evaluated the midterm outcomes for this conduit.

METHODS

This retrospective study included a total of 72 patients who underwent right ventricular outflow tract reconstruction with ePTFE valved conduits between January 2014 and June 2020. During follow-up, echocardiograms were performed for all patients, and magnetic resonance imaging was performed for patients with repaired tetralogy of Fallot.

RESULTS

Patients had a median age of 69 months (interquartile range, 28-127 months) and a median follow-up period of 33 months (interquartile range, 9-51 months). There was no early death, but 2 late deaths (2.78%) occurred. The median conduit size was 18 mm (interquartile range, 18-20 mm) and the z score was +1.3 (interquartile range, +0.6-+2). Peak velocity across the ePTFE valve was 2.38 m/s (95% CI, 2.11-2.63 m/s). Pulmonary valve regurgitation was none or trivial in 27 (38.5%) patients, mild in 42 (60.0%) patients, and moderate in 1 (1.4%) patient. Conduit dysfunction occurred in 5 patients: 4 had moderate conduit stenosis, and 1 had moderate regurgitation. The right ventricular end-diastolic volume index in repaired tetralogy of Fallot was significantly decreased after surgery (171 mL/m vs 130 mL/m; P < .001). No reintervention or conduit replacement was needed.

CONCLUSIONS

This handsewn ePTFE valved conduit was associated with appreciable hemodynamic outcomes during the midterm follow-up period. Long-term follow-up studies are needed to corroborate these findings.

摘要

背景

已有多种右心室流出道重建的管道被报道,但其中大多数在中国不可用。研究人员使用膨化聚四氟乙烯(ePTFE)开发了一种简单的手工缝制带瓣管道。本研究评估了该管道的中期结果。

方法

本回顾性研究共纳入 2014 年 1 月至 2020 年 6 月期间接受 ePTFE 带瓣管道右心室流出道重建的 72 例患者。随访期间,所有患者均行超声心动图检查,修复法洛四联症患者行磁共振成像检查。

结果

患者的中位年龄为 69 个月(四分位距,28-127 个月),中位随访时间为 33 个月(四分位距,9-51 个月)。无早期死亡,但有 2 例晚期死亡(2.78%)。中位管道直径为 18mm(四分位距,18-20mm),Z 值为+1.3(四分位距,+0.6-+2)。ePTFE 瓣口的峰值流速为 2.38m/s(95%CI,2.11-2.63m/s)。27 例(38.5%)患者瓣周漏为无或微量,42 例(60.0%)患者为轻度,1 例(1.4%)患者为中度。5 例发生管道功能障碍:4 例为中度管道狭窄,1 例为中度反流。法洛四联症修复术后右心室舒张末期容积指数明显下降(171ml/m 比 130ml/m;P<0.001)。无需再次干预或更换管道。

结论

这种手工缝制的 ePTFE 带瓣管道在中期随访期间具有可观的血流动力学效果。需要进行长期随访研究来证实这些发现。

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