Huang Ying, Cai Xiaowei, Zhong Lishan, Xie Wen, Lou Qi, Ma Jianrui, Chen Jimei, Zhuang Jian, Wen Shusheng, Zhao Junfei
Department of Cardiovascular Surgery, Guangdong Cardiovascular Institute, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China.
Department of Thoracic and Cardiovascular Surgery, Zhongnan Hospital of Wuhan University, Wuhan, China.
Front Cardiovasc Med. 2023 Jan 9;9:1068752. doi: 10.3389/fcvm.2022.1068752. eCollection 2022.
Pulmonary arterial end-diastolic forward flow (EDFF) following repaired tetralogy of Fallot (rTOF) is recognized as right ventricular (RV) restrictive physiology, which is closely related to poor prognosis. This study sought to review mid-term experience and investigate the risk factors of EDFF in the rTOF patients.
From September 2016 to January 2019, 100 patients (age < 18 years old) who underwent complete tetralogy of Fallot (TOF) repair were enrolled and were divided into EDFF group ( = 52) and non-EDFF group ( = 48) based on the presence of postoperative EDFF. Elastic net analysis was performed for variable selection. Univariate and multivariate logistic analyses were used to analyze the correlation between risk factors and EDFF.
End-diastolic forward flow group had lower systolic blood pressure ( = 0.037), diastolic blood pressure ( = 0.027), and higher vasoactive-inotrope score within 24 h after surgery ( = 0.022) than non-EDFF group. Transannular patch (TAP) was an independent predictor of postoperative EDFF [ = 0.029, OR: 2.585 (1.102∼6.061)]. Patients were followed up for a median of 2.6 years [interquartile range (IQR) 1.6] after the first TOF repair. During follow-up, the prevalence of the EDFF was lower in those with pulmonary valve (PV) reconstructions than that in those undergoing patch enlargement without PV reconstructions in the primary TOF repair ( < 0.001).
End-diastolic forward flow was associated with TAP. Patients with EDFF might have a transient hemodynamic instability in the early postoperative period. PV reconstructions in the TOF repair might reduce the incidence of EDFF in the mid-term follow-up.
法洛四联症修复术后（rTOF）肺动脉舒张末期前向血流（EDFF）被认为是右心室（RV）限制性生理表现，这与不良预后密切相关。本研究旨在回顾中期经验并调查rTOF患者中EDFF的危险因素。
2016年9月至2019年1月，纳入100例接受法洛四联症（TOF）完全修复的患者（年龄<18岁），根据术后是否存在EDFF分为EDFF组（n = 52）和非EDFF组（n = 48）。进行弹性网分析以选择变量。采用单因素和多因素逻辑回归分析来分析危险因素与EDFF之间的相关性。
舒张末期前向血流组术后24小时内的收缩压（P = 0.037）、舒张压（P = 0.027）低于非EDFF组，血管活性药物评分高于非EDFF组（P = 0.022）。跨环补片（TAP）是术后EDFF的独立预测因素[P = 0.029，OR：2.585（1.102～6.061）]。首次TOF修复术后患者的中位随访时间为2.6年[四分位间距（IQR）1.6]。随访期间，在初次TOF修复中，行肺动脉瓣（PV）重建者的EDFF发生率低于未行PV重建而行补片扩大者（P<0.001）。
舒张末期前向血流与TAP有关。EDFF患者术后早期可能存在短暂的血流动力学不稳定。TOF修复术中的PV重建可能会降低中期随访中EDFF的发生率。
