一种用于室间隔缺损合并肺动脉闭锁及主要体肺侧支动脉单期完全修复并单源化的新型三维可视化手术方法。
A Novel 3D Visualized Operative Procedure in the Single-Stage Complete Repair With Unifocalization of Pulmonary Atresia With Ventricular Septal Defect and Major Aortopulmonary Collateral Arteries.
作者信息
Qiu Hailong, Wen Shusheng, Ji Erchao, Chen Tianyu, Liu Xiaobing, Li Xiaohua, Teng Yun, Zhang Yong, Liufu Rong, Zhang Jiawei, Xu Xiaowei, Chen Jimei, Huang Meiping, Cen Jianzheng, Zhuang Jian
机构信息
Department of Cardiovascular Surgery, Guangdong Cardiovascular Institute, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China.
Laboratory of Artificial Intelligence and 3D Technologies for Cardiovascular Diseases, Guangdong Provincial Key Laboratory of South China Structural Heart Disease, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China.
出版信息
Front Cardiovasc Med. 2022 Apr 25;9:836200. doi: 10.3389/fcvm.2022.836200. eCollection 2022.
OBJECTIVES
Pulmonary atresia with ventricular septal defect and major aortopulmonary collateral arteries (PA/VSD/MAPCAs) is a relatively rare, complex, and heterogeneous congenital heart disease. As one of the effective treatments, the midline unifocalization strategy still remains complicated and challenging due to the diverse forms of MAPCAs and pulmonary arteries. The purpose of this study is to summarize our experience of a novel three-dimensional (3D) visualized operative procedure in the single-stage complete repair with unifocalization and to clarify the benefits it may bring to us.
METHODS
We described our experience of the 3D visualized operative procedure such as 3D printing, virtual reality (VR), and mixed reality (MR) technology in patients with PA/VSD/MAPCAs who underwent a single-stage complete repair with unifocalization. The data from the patients who underwent this procedure (3D group) and those who underwent the conventional procedure (conventional group) were compared.
RESULTS
The conventional and 3D groups included 11 patients from September 2011 to December 2017 and 9 from January 2018 to March 2021, respectively. The baseline characteristics such as age, body weight, preoperative saturation, the anatomy of the pulmonary arteries and MAPCAs, the Nakata index, and TNPAI had no statistical significance. All 9 patients in the 3D group were operated only through a median sternotomy, while 8 cases (72.7%) in the conventional group needed another posterolateral thoracotomy ( = 0.001). In the 3D group, the CPB time was shorter (93.2 ± 63.8 vs. 145.1 ± 68.4 min, = 0.099), and the median pre-CPB time per MAPCAs was significantly shorter [25.7 (14.0, 46.3) vs. 65 (41.3, 75.0) min, = 0.031]. There was no early death in the 3D group, while there were 3 in the conventional group (0 vs. 27.3%, = 0.218).
CONCLUSION
The novel 3D visualized operative procedure may help improve the performance of the single-stage complete repair with the midline unifocalization of PA/VSD/MAPCAs and help shorten the dissecting time of the MAPCAs. It may promote the routine and successful application of this strategy in more centers.
目的
室间隔缺损合并主-肺动脉侧支血管的肺动脉闭锁（PA/VSD/MAPCAs）是一种相对罕见、复杂且异质性的先天性心脏病。作为有效的治疗方法之一，中线单源化策略由于MAPCAs和肺动脉的多样形式，仍然复杂且具有挑战性。本研究的目的是总结我们在单阶段完全修复联合单源化中采用新型三维（3D）可视化手术方法的经验，并阐明其可能给我们带来的益处。
方法
我们描述了在接受单阶段完全修复联合单源化的PA/VSD/MAPCAs患者中应用3D打印、虚拟现实（VR）和混合现实（MR）技术等3D可视化手术方法的经验。比较了接受该手术方法的患者（3D组）和接受传统手术方法的患者（传统组）的数据。
结果
传统组和3D组分别包括2011年9月至2017年12月的11例患者和2018年1月至2021年3月的9例患者。年龄、体重、术前饱和度、肺动脉和MAPCAs的解剖结构、中田指数和TNPAI等基线特征无统计学意义。3D组的所有9例患者仅通过正中胸骨切开术进行手术，而传统组中有8例（72.7%）需要另做后外侧开胸手术（P = 0.001）。3D组的体外循环时间较短（93.2±63.8 vs. 145.1±68.4分钟，P = 0.099），且每个MAPCAs的体外循环前中位时间显著缩短[25.7（14.0，46.3）vs. 65（41.3，75.0）分钟，P = 0.031]。3D组无早期死亡病例，而传统组有3例（0 vs. 27.3%，P = 0.218）。
结论
新型3D可视化手术方法可能有助于提高PA/VSD/MAPCAs中线单源化单阶段完全修复的手术效果，并有助于缩短MAPCAs的解剖时间。它可能促进该策略在更多中心的常规和成功应用。
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