National Center for Cardiovascular Diseases, Pediatric Cardiac Center, Fuwai Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, No. 167 Beilishi Street, Xicheng District, Beijing 100037, China.
Department of Echocardiography, National Center for Cardiovascular Diseases, Fuwai Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, No. 167 Beilishi Street, Xicheng District, Beijing 100037, China.
World J Pediatr. 2022 Mar;18(3):206-213. doi: 10.1007/s12519-021-00498-x. Epub 2022 Jan 23.
This study aimed to investigate the performance of handmade tri-leaflet expanded polytetrafluoroethylene (ePTFE) conduits in the absence of a suitable homograft.
Patients who underwent right ventricular outflow tract reconstruction with tri-leaflet ePTFE conduits or homografts between December 2016 and August 2020 were included. The primary endpoint was the incidence of moderate or severe conduit stenosis (≥ 36 mmHg) and/or moderate or severe insufficiency. The secondary endpoint was the incidence of severe conduit stenosis (≥ 64 mmHg) and/or severe insufficiency.
There were 102 patients in the ePTFE group and 52 patients in the homograft group. The median age was younger [34.5 (interquartile range: 20.8-62.8) vs. 60.0 (interquartile range: 39.3-81.0) months, P = 0.001] and the median weight was lower [13.5 (10.0-19.0) vs. 17.8 (13.6-25.8) kg, P = 0.003] in the ePTFE group. The conduit size was smaller (17.9 ± 2.2 vs. 20.5 ± 3.0 mm, P < 0.001) and the conduit Z score was lower (1.48 ± 1.04 vs. 1.83 ± 1.05, P = 0.048) in the ePTFE group. There was no significant difference in the primary endpoints (log rank, P = 0.33) and secondary endpoints (log rank, P = 0.35). Multivariate analysis identified lower weight at surgery [P = 0.01; hazard ratio: 0.75; 95% confidence interval (CI) 0.59-0.94] and homograft conduit use (P = 0.04; hazard ratio: 8.43; 95% CI 1.14-62.29) to be risk factors for moderate or severe conduit insufficiency. No risk factors were found for moderate or severe conduit stenosis or conduit dysfunction on multivariate analysis.
Handmade tri-leaflet ePTFE conduits showed acceptable early and midterm outcomes in the absence of a suitable homograft, but a longer follow-up is needed.
本研究旨在探讨在没有合适同种移植物的情况下，手工三叶瓣膨体聚四氟乙烯（ePTFE）管道的性能。
纳入 2016 年 12 月至 2020 年 8 月期间行右心室流出道重建的三叶瓣 ePTFE 管道或同种移植物患者。主要终点是中重度管道狭窄（≥36mmHg）和/或中重度关闭不全的发生率。次要终点是重度管道狭窄（≥64mmHg）和/或重度关闭不全的发生率。
ePTFE 组 102 例，同种移植物组 52 例。ePTFE 组的中位年龄较小[34.5（四分位距：20.8-62.8）岁，比同种移植物组的 60.0（四分位距：39.3-81.0）岁，P=0.001]，中位体重较轻[13.5（10.0-19.0）kg，比同种移植物组的 17.8（13.6-25.8）kg，P=0.003]。ePTFE 组的管道尺寸较小（17.9±2.2mm，比同种移植物组的 20.5±3.0mm，P<0.001），Z 评分较低（1.48±1.04，比同种移植物组的 1.83±1.05，P=0.048）。主要终点（对数秩检验，P=0.33）和次要终点（对数秩检验，P=0.35）无显著差异。多变量分析确定手术时体重较轻（P=0.01；风险比：0.75；95%置信区间（CI）0.59-0.94）和同种移植物使用（P=0.04；风险比：8.43；95%CI 1.14-62.29）是中重度管道关闭不全的危险因素。多变量分析未发现中重度管道狭窄或管道功能障碍的危险因素。
在没有合适同种移植物的情况下，手工三叶瓣 ePTFE 管道的早期和中期结果可接受，但需要更长时间的随访。
