Department of Congenital Heart Surgery, National Heart Hospital, Sofia, Bulgaria.
Pediatric Cardiac Intensive Care Unit, National Heart Hospital, Sofia, Bulgaria.
Braz J Cardiovasc Surg. 2023 Aug 4;38(5):e20220341. doi: 10.21470/1678-9741-2022-0341.
Homografts and bovine jugular vein are the most commonly used conduits for right ventricular outflow tract reconstruction at the time of primary repair of truncus arteriosus.
We reviewed all truncus patients from 1990 to 2020 in two mid-volume centers. Inclusion criteria were primary repair, age under one year, and implantation of either homograft or bovine jugular vein. Kaplan-Meier analysis was used to estimate survival, freedom from reoperation on right ventricular outflow tract, and freedom from right ventricular outflow tract reoperation or catheter intervention.
Seventy-three patients met the inclusion criteria, homografts were implanted in 31, and bovine jugular vein in 42. There was no difference in preoperative characteristics between the two groups. There were 25/73 (34%) early postoperative deaths and no late deaths. Follow-up for survivals was 17.5 (interquartile range 13.5) years for homograft group, and 11.5 (interquartile range 8.5) years for bovine jugular vein group (P=0.002). Freedom from reoperation on right ventricular outflow tract at one, five, and 10 years in the homograft group were 100%, 83%, and 53%; and in bovine jugular vein group, it was 100%, 85%, and 50% (P=0.79). There was no difference in freedom from reoperation or catheter intervention (P=0.32).
Bovine jugular vein was equivalent to homografts up to 10 years in terms of survival and freedom from right ventricular outflow tract reoperation or catheter intervention. The choice of either valved conduit did not influence the durability of the right ventricle-pulmonary artery conduit in truncus arteriosus.
在主修复动脉干时，同种异体移植物和牛颈静脉是右心室流出道重建最常用的移植物。
我们回顾了两个中等容量中心 1990 年至 2020 年期间所有的动脉干患者。纳入标准为初次修复、年龄小于 1 岁、植入同种异体移植物或牛颈静脉。使用 Kaplan-Meier 分析来估计生存率、右心室流出道免于再次手术的生存率和右心室流出道免于再次手术或导管介入的生存率。
73 例患者符合纳入标准，其中 31 例植入同种异体移植物，42 例植入牛颈静脉。两组患者术前特征无差异。术后早期死亡 25/73（34%），无晚期死亡。同种异体移植物组的生存随访时间为 17.5（四分位间距 13.5）年，牛颈静脉组为 11.5（四分位间距 8.5）年（P=0.002）。同种异体移植物组右心室流出道免于再次手术的 1 年、5 年和 10 年生存率分别为 100%、83%和 53%；牛颈静脉组分别为 100%、85%和 50%（P=0.79）。免于再次手术或导管介入的生存率无差异（P=0.32）。
在生存和右心室流出道免于再次手术或导管介入方面，牛颈静脉与同种异体移植物在 10 年内等效。选择带瓣移植物并不影响动脉干的右心室-肺动脉通道的耐久性。
