Lv Lizhi, Lang Xinyue, Zhang Simeng, Wang Cheng, Jin Yuanhao, Wang Qiang
Center for Pediatric Cardiac Surgery, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100037, China.
Department of Cardiac Surgery, Yunnan Fuwai Cardiovascular Hospital, Kunming 650102, China.
J Clin Med. 2023 Feb 21;12(5):1731. doi: 10.3390/jcm12051731.
This study aimed to assess the early and mid-term results of the modified Doty's technique compared with the traditional Doty's technique in patients with congenital supravalvular aortic stenosis (SVAS). We retrospectively included 73 consecutive SVAS patients in Beijing and Yunnan Fuwai Hospitals between 2014 and 2021. Patients were divided into the modified technique ( = 9) and the traditional technique group ( = 64). The modified technique involves altering the right head of the symmetrical inverted pantaloon-shaped patch into an asymmetrical triangular form to prevent compression of the right coronary artery ostium. The primary safety outcome was in-hospital surgery-related complications and the primary effectiveness outcome was re-operation at follow-up. The Mann-Whitney U test and Fisher's exact test were used to test the group difference. The median age at operation was 50 months (IQR 27.0-96.0). Twenty-two (30.1%) of the patients were female. The median follow-up was 23.5 months (IQR 3.0-46.0). No in-hospital surgery-related complications and follow-up re-operation occurred in the modified technique group, but the traditional technique group had 14 (21.8%) surgery-related complications and 5 (7.9%) re-operation. Patients with the modified technique had a well-developed aortic root and no aortic regurgitation occurred. A modified technique could be considered for patients with poor aortic root development to reduce postoperative surgery-related complications.
本研究旨在评估改良多蒂技术与传统多蒂技术相比,用于先天性瓣上主动脉狭窄(SVAS)患者的早期和中期结果。我们回顾性纳入了2014年至2021年期间在北京和云南阜外医院连续就诊的73例SVAS患者。患者被分为改良技术组(n = 9)和传统技术组(n = 64)。改良技术是将对称倒裤形补片的右侧头部改为不对称三角形,以防止右冠状动脉口受压。主要安全结局是住院期间与手术相关的并发症,主要有效性结局是随访时再次手术。采用曼-惠特尼U检验和费舍尔精确检验来检验组间差异。手术时的中位年龄为50个月(四分位间距27.0 - 96.0)。22例(30.1%)患者为女性。中位随访时间为23.5个月(四分位间距3.0 - 46.0)。改良技术组未发生住院期间与手术相关的并发症和随访时再次手术,但传统技术组有14例(21.8%)与手术相关的并发症和5例(7.9%)再次手术。采用改良技术的患者主动脉根部发育良好,未发生主动脉瓣反流。对于主动脉根部发育不良的患者,可考虑采用改良技术以减少术后与手术相关的并发症。