Singh Sameer K, Faridmoayer Erfan, Vitale Nicolo, Woodard Evan, Xue Yingfei, Abramov Alexey, Levy Robert J, Ferrari Giovanni
Department of Surgery, Columbia University, New York, NY, USA.
Università Degli Studi di Milano, Milan, Italy.
Pediatr Cardiol. 2025 Jan;46(1):14-26. doi: 10.1007/s00246-023-03346-z. Epub 2023 Dec 2.
The need for right ventricular outflow tract reconstruction is common and growing in congenital heart surgery given expanding indications for the repair of congenital as well as acquired heart disease. Various valved conduit options currently exist including homografts, xenograft pulmonary valved conduits (Contegra™), and porcine valved conduits. The major limitation for all conduits is implant durability, which requires reoperation. Currently, cryopreserved homografts are often used given their superiority shown in long-term data. Significant limitations remain in the cost and availability of the graft, particularly for smaller sizes. Contegra conduits are available in a variety of sizes. Nonetheless, the data regarding long-term durability are less robust and studies comparing durability with homografts have been conflicting. Additionally, there is concern for increased rates of late endocarditis in this conduit. Porcine valved conduits offer a reliable option but are limited by structural valve degeneration associated with all types of bioprosthetic heart valve replacements. New developments in the field of tissue engineering have produced promising bio-restorative valved conduits that may overcome many of the limitations of previous conduit technologies. These remain in the early stages of clinical testing. This review summarizes the clinical data surrounding the conduits used most commonly in clinical practice today and explores emerging technologies that may bring us closer to developing the ideal conduit.
鉴于先天性和后天性心脏病修复的适应证不断扩大,在先天性心脏病手术中,右心室流出道重建的需求很常见且日益增加。目前存在多种带瓣管道选择,包括同种异体移植物、异种移植肺动脉带瓣管道(Contegra™)和猪带瓣管道。所有管道的主要限制是植入耐久性,这需要再次手术。目前,鉴于其在长期数据中显示出的优势,冷冻保存的同种异体移植物经常被使用。移植物的成本和可获得性仍然存在重大限制,特别是对于较小尺寸的移植物。Contegra管道有多种尺寸可供选择。尽管如此,关于长期耐久性的数据并不那么可靠,并且比较其与同种异体移植物耐久性的研究结果相互矛盾。此外,人们担心这种管道后期心内膜炎的发生率会增加。猪带瓣管道提供了一种可靠的选择,但受到与所有类型生物人工心脏瓣膜置换相关的结构性瓣膜退变的限制。组织工程领域的新进展产生了有前景的生物修复带瓣管道,可能克服先前管道技术的许多限制。这些仍处于临床试验的早期阶段。本综述总结了当今临床实践中最常用管道的临床数据,并探索了可能使我们更接近开发理想管道的新兴技术。