Li Cong, Ma Jidan, Yan Yichen, Chen Hongtong, Shi Guocheng, Chen Huiwen, Zhu Zhongqun
Department of Cardiothoracic Surgery, Shanghai Children's Medical Center, School of Medicine, Shanghai Jiao Tong University, Shanghai, China.
Department of Pediatric Cardiology, Shanghai Children's Medical Center, School of Medicine, Shanghai Jiao Tong University, Shanghai, China.
Transl Pediatr. 2022 Mar;11(3):330-339. doi: 10.21037/tp-21-557.
Although various surgical techniques have been reported for aortic arch reconstruction for proximal and distal transverse arch (PDTA) hypoplasia, no consensus has been reached on a surgical option for initial arch reconstruction. This study was undertaken to review various arch reconstruction options for PDTA hypoplasia in Chinese infants.
A retrospective review of 121 infants who underwent initial arch reconstruction of the proximal and distal aortic arches between 2010 and 2020 was performed. Freedom from recoarctation was analyzed using Kaplan-Meier analysis. Univariate and multivariable Cox regression analyses were performed to determine perioperative data associated with an increased risk of recoarctation after surgery.
Aortic arch reconstruction was performed by end-to-side anastomosis (ESA) (n=37) or patch repair [autologous pericardial patch (APP), n=53; bovine pericardial patch (BPP), n=20; autologous pulmonary artery patch (APAP), n=11]. The relative diameter of the proximal arch was 0.51±0.07, and the relative diameter of the distal arch was 0.43±0.07. The median follow-up time was 679 (range, 388-1,362) days. Recoarctation was observed in 44 (36.4%) patients. ESA was an independent risk factor for further development of recoarctation after the initial aortic arch reconstruction [hazard ratio (HR) =2.13; P=0.020].
Aortic arch reconstruction via ESA was an independent risk factor for late recoarctation of the proximal and distal aortic arches in patients who underwent the initial surgery in infancy.
Chinese Clinical Trials Registry ChiCTR2100048212.
尽管已有多种手术技术用于近端和远端横弓（PDTA）发育不全的主动脉弓重建，但对于初次弓部重建的手术方案尚未达成共识。本研究旨在回顾中国婴儿PDTA发育不全的各种弓部重建方案。
对2010年至2020年间接受初次近端和远端主动脉弓重建的121例婴儿进行回顾性研究。采用Kaplan-Meier分析评估无再缩窄生存率。进行单因素和多因素Cox回归分析，以确定与术后再缩窄风险增加相关的围手术期数据。
主动脉弓重建采用端侧吻合术（ESA）（n = 37）或补片修补术[自体心包补片（APP），n = 53；牛心包补片（BPP），n = 20；自体肺动脉补片（APAP），n = 11]。近端弓的相对直径为0.51±0.07，远端弓的相对直径为0.43±0.07。中位随访时间为679（范围388 - 1362）天。44例（36.4%）患者出现再缩窄。ESA是初次主动脉弓重建后再缩窄进一步发展的独立危险因素[风险比（HR）= 2.13；P = 0.020]。
对于婴儿期接受初次手术的患者，通过ESA进行主动脉弓重建是近端和远端主动脉弓晚期再缩窄的独立危险因素。
中国临床试验注册中心ChiCTR2100048212
