Department of Cardiothoracic Surgery, Children's Hospital of Fudan University, Shanghai, China.
Department of Cardiothoracic Surgery, Children's Hospital of Fudan University, Shanghai, China.
Ann Thorac Surg. 2022 Nov;114(5):1778-1785. doi: 10.1016/j.athoracsur.2021.09.051. Epub 2021 Oct 27.
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.
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.
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.
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.
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。
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。
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。
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。