Division of Cardiothoracic Surgery, Department of Surgery, Faculty of Medicine, Ramathibodi Hospital, Mahidol University, Bangkok, Thailand.
J Cardiothorac Surg. 2023 Sep 15;18(1):259. doi: 10.1186/s13019-023-02362-7.
Since the introduction of surgical implantation of conduit for right ventricle-to-pulmonary artery pathway reconstruction, there has been a number of studies on possible factors which might potentially affect conduit longevity, as well as patient's reintervention-free and overall survival. Still, no definite consensual agreement could be made thus far. We aimed to compare conduit longevity, reintervention-free survival, and overall survival between patients with congenital heart diseases indicated for operations involving right ventricle-to-pulmonary artery pathway reconstruction whose conduits were placed heterotopically to those with orthotopically placed ones.
We retrospectively collected data from electronic medical records of Ramathibodi hospital from 1st January 2005 to 31st December 2022. Patients with congenital heart diseases whose operations involved reconstruction of right ventricle-to-pulmonary artery continuity were included. Patients whose medical record data were significantly missing were excluded. Demographic data, operative, and postoperative details were collected and reviewed.
There were 67 patients included in our study, with 25 receiving orthotopic and the other 42 receiving heterotopic conduit implantation. Conduit dysfunction-free, reintervention-free, and overall survival were not statistically different between both groups. There was 1 early and no late death up to the end date of our study.
Conduits placed on a heterotopic position did not result in worse longevity, reintervention-free survival, as well as overall survival when compared to conduits placed on an orthotopic position. This suggested that the less technically demanding heterotopic conduit placement could be recommended as an operation of choice for right ventricular outflow tract reconstruction.
自外科植入右心室至肺动脉途径重建管道以来，已有许多研究探讨了可能影响管道寿命以及患者无再介入和总体生存的潜在因素。尽管如此，迄今为止仍未达成明确的共识。我们旨在比较患有先天性心脏病并需要进行右心室至肺动脉途径重建手术的患者，其管道异位放置与原位放置的管道的寿命、无再介入生存率和总体生存率。
我们回顾性地从 2005 年 1 月 1 日至 2022 年 12 月 31 日从 Ramathibodi 医院的电子病历中收集数据。纳入患有先天性心脏病且手术涉及重建右心室至肺动脉连续性的患者。排除病历数据明显缺失的患者。收集并审查人口统计学数据、手术和术后细节。
我们的研究共纳入 67 例患者，其中 25 例接受了原位和另外 42 例接受了异位管道植入。两组患者的管道无功能障碍、无再介入和总体生存率均无统计学差异。在我们的研究结束日期之前，有 1 例早期死亡，无晚期死亡。
与原位放置的管道相比，异位放置的管道不会导致寿命、无再介入生存率以及总体生存率更差。这表明，对于右心室流出道重建，技术要求较低的异位管道放置可以作为首选手术。
