Cao Yuchen, Asai Hidetsugu, Niwano Haruki, Furukawa Yurika, Ikarashi Jin, Tachibana Tsuyoshi
Division of Cardiovascular Surgery, Kanagawa Children's Medical Center, Yokohama, Japan.
Kyobu Geka. 2022 Nov;75(12):991-998.
Although valve sparing (VS) for patients with smaller pulmonary valves has been increasing, transannular patch repair( TAP) accounts for more than half of the total tetralogy of Fallot corrections worldwide. We use fresh autologous pericardial patches to perform a modified TAP procedure with pulmonary valve leaflet augmentation as proposed by Sung et al. We aimed to explore the early and midterm outcomes of this procedure.
We retrospectively reviewed 37 patients( group TAP:12;group VS:25) who underwent total tetralogy of Fallot corrections from April 2018 to December 2021.
No midterm mortality was observed at a median observation period of 20.4 months in both groups. The midterm rates of freedom from moderate or more pulmonary regurgitation( PR) were 64.2 % and 21.4% in group TAP and 100% and 100% in group VS at 1 and 3 years, respectively( p<0.001). The midterm rates of freedom from pulmonary stenosis reintervention were 100% and 100% in group TAP and 96% and 96% in group VS at 1 and 3 years, respectively( p=0.51).
TAP showed acceptable midterm survival and reintervention rate. Longer follow-up is essential considering the significantly higher PR in the postoperative period in group TAP.
尽管针对较小肺动脉瓣患者的保留瓣膜（VS）手术有所增加，但在全球范围内，经环补片修补术（TAP）在法洛四联症矫正手术总量中仍占半数以上。我们采用新鲜自体心包补片，按照Sung等人提出的方法，实施了带有肺动脉瓣叶扩大术的改良TAP手术。我们旨在探讨该手术的早期和中期结果。
我们回顾性分析了2018年4月至2021年12月期间接受法洛四联症矫正手术的37例患者（TAP组：12例；VS组：25例）。
两组在中位观察期20.4个月时均未观察到中期死亡。TAP组和VS组在1年和3年时，中度及以上肺动脉反流（PR）的中期无反流率分别为64.2%和21.4%，以及100%和100%（p<0.001）。TAP组和VS组在1年和3年时，肺动脉狭窄再次干预的中期无干预率分别为100%和100%，以及96%和96%（p=0.51）。
TAP显示出可接受的中期生存率和再次干预率。鉴于TAP组术后PR明显更高，进行更长时间的随访至关重要。
