Département medico-chirurgical de cardiopathie congénitale et pédiatrique, CHU de Nantes, Quai Moncousu, Nantes, France.
J Card Surg. 2022 Oct;37(10):3232-3242. doi: 10.1111/jocs.16827. Epub 2022 Aug 10.
Direct anastomosis, like end-to-end anastomosis or end-to-side anastomosis, is commonly employed to repair aortic coarctation or interrupted aortic arch. Direct anastomosis of the aorta, however, may result in restenosis or bronchial compression. To circumvent these complications, we have applied a technique consisting of aortic reconstruction using glutaraldehyde-fixed autologous pericardial patches.
Our database was queried for infants who underwent aortic arch reconstruction using autologous pericardial patches from 2007 to 2019. Medical records, including echography imaging, were reviewed, and Z-scores of aortic arch diameters were retrospectively assessed at baseline, immediately after surgery, and at follow-up end.
Overall, 58 patients met the inclusion criteria, with a median age of 9.8 days at surgery and median postoperative follow-up of 46 months. Re-coarctation requiring re-intervention by either surgery or percutaneous angioplasty was documented in 14.7% of patients. Overall, 9% of patients died of all-cause mortality. The Z-scores evolved favorably from baseline, which clearly indicated hypoplastic aortic arch, to early postoperative status, which clearly showed values close to those obtained in normal infants, with likewise normal values obtained at median 46-month follow-up.
Glutaraldehyde-fixed autologous pericardial patches were shown to provide correct medium-term results for aortic arch reconstruction. The incidence of restenosis requiring re-intervention was shown to be low. Autologous pericardial patches can be considered as an acceptable and easily available solution for aortic arch repair surgery.
直接吻合术，如端端吻合术或端侧吻合术，常用于修复主动脉缩窄或主动脉弓中断。然而，主动脉直接吻合可能导致再狭窄或支气管压迫。为了避免这些并发症，我们应用了一种技术，包括使用戊二醛固定的自体心包片进行主动脉重建。
我们对 2007 年至 2019 年期间使用自体心包片进行主动脉弓重建的婴儿进行了数据库检索。回顾了病历记录，包括超声心动图图像，并对主动脉弓直径的 Z 分数进行了回顾性评估，分别在基线、手术后即刻和随访结束时进行评估。
总体而言，58 名患者符合纳入标准，手术时的中位年龄为 9.8 天，术后中位随访时间为 46 个月。记录到 14.7%的患者需要再次手术或经皮血管成形术干预的再狭窄。总体而言，9%的患者因各种原因死亡。Z 分数从基线时明显表示主动脉弓发育不良的情况，发展到术后早期时明显接近正常婴儿的数值，中位 46 个月随访时同样获得了正常的数值。
戊二醛固定的自体心包片为主动脉弓重建提供了良好的中期结果。需要再次干预的再狭窄发生率较低。自体心包片可被视为主动脉弓修复手术的一种可接受且易于获得的解决方案。
