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法洛四联症患者同种异体移植退化后牛颈静脉导管置换术:再次手术病例的结果

Bovine jugular vein conduit replacement after homograft degeneration in patients with tetralogy of Fallot: The results of re-redo cases.

作者信息

Işık Onur, Akyüz Muhammet, Mercan İlker

机构信息

Department of Pediatric Cardiovascular Surgery, University of Health Sciences, Tepecik Training and Research Hospital, Izmir, Türkiye.

出版信息

Turk Gogus Kalp Damar Cerrahisi Derg. 2023 Apr 28;31(2):199-206. doi: 10.5606/tgkdc.dergisi.2023.24057. eCollection 2023 Apr.

Abstract

BACKGROUND

This study aims to present our experience and results in terms of reconstruction with bovine jugular vein conduit in re-redo patients who developed severe homograft degeneration with pulmonary homograft valve replacement.

METHODS

Between May 2018 and May 2021, a total of 10 re-redo patients (4 males, 6 females; mean age: 16.5±3.0 years; range, 12 to 21 years) who underwent bovine jugular vein conduit replacement due to homograft degeneration were retrospectively analyzed. The clinical, pre-, intra-, and postoperative data of the patients were recorded.

RESULTS

The mean age of the second operation (homograft replacement) was 8.5±3.8 (range, 4 to 14) years in the patients who underwent homograft replacement. No postoperative mortality was observed. When the pre- and postoperative findings were compared, the right ventricular outflow tract gradient, the degree of pulmonary and tricuspid regurgitation, and right ventricular dilatation were regressed (p<0.05). A significant improvement in the New York Heart Association functional class was observed in all patients after surgery.

CONCLUSION

After tetralogy of Fallot corrective surgery, repetitive surgical interventions are inevitable due to pulmonary valve deterioration. Therefore, a bovine jugular vein conduit may be a good alternative for conduit preference after pulmonary homograft failure in re-redo cases.

摘要

背景

本研究旨在介绍我们在因肺动脉同种异体瓣膜置换术后发生严重同种异体移植物退变的再次手术患者中,使用牛颈静脉导管进行重建的经验和结果。

方法

回顾性分析2018年5月至2021年5月期间,因同种异体移植物退变而接受牛颈静脉导管置换的10例再次手术患者(4例男性,6例女性;平均年龄:16.5±3.0岁;范围12至21岁)。记录患者的临床、术前、术中和术后数据。

结果

接受同种异体瓣膜置换的患者第二次手术(同种异体瓣膜置换)的平均年龄为8.5±3.8(范围4至14)岁。未观察到术后死亡。比较术前和术后结果时,右心室流出道梯度、肺动脉和三尖瓣反流程度以及右心室扩张均有所改善(p<0.05)。术后所有患者的纽约心脏协会功能分级均有显著改善。

结论

法洛四联症矫正手术后,由于肺动脉瓣退变,重复手术干预不可避免。因此,在再次手术病例中,当肺动脉同种异体移植物失败后,牛颈静脉导管可能是导管选择的一个良好替代方案。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/4cd4/10357866/dda0dca63367/TJTCS-2023-31-2-199-206-F1.jpg

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