Wang Zhangwei, Ma Kai, Li Shoujun
Department of Cardiovascular Surgery, Chinese Academy of Medical Sciences and Peking Union Medical College, National Center for Cardiovascular Diseases, Fuwai Hospital, No.167 Beilishi Road, Xicheng District, Beijing, China.
Pediatr Cardiol. 2025 Aug;46(6):1649-1660. doi: 10.1007/s00246-024-03582-x. Epub 2024 Jul 23.
We conducted a retrospective review of patients who underwent valved homograft conduits (VHC) for right ventricular outflow tract (RVOT) reconstruction at our center. Long-term outcomes were analyzed, and risk factors affecting the long-term durability of VHC were explored. Kaplan-Meier survival curves were used to evaluate survival, freedom from VHC reintervention, and freedom from VHC dysfunction. Multivariate Cox proportional hazards regression model was used to analyze the risk factors for late VHC dysfunction. A total of 290 patients who underwent VHC for RVOT reconstruction in our center were enrolled. Seven patients occurred early death, all of which were in the non-Ross group. Two hundred and sixty-five patients were followed up for 85 (0.3-176.0) months. Six patients occurred late death, all in the non-Ross group. Six patients underwent VHC reintervention. During the follow-up period, 52 patients developed VHC dysfunction. Freedom from VHC dysfunction was higher in the Ross group than in the non-Ross group in the whole cohort. Multivariate Cox regression analysis showed that age < 6 years and non-Ross operation were independent risk factors for VHC dysfunction. Freedom from VHC dysfunction was higher in the Ross group than in the non-Ross group in patients younger than 6 years of age at surgery. However, there was no significant difference in freedom from VHC dysfunction between the two groups in patients older than 6 years. Long-term outcomes of VHC for RVOT reconstruction are satisfactory. Age < 6 years and non-Ross operation are independent risk factors for VHC dysfunction. The long-term survival rate and durability of VHC in Ross group were better than those in non-Ross group. The advantage of long-term durability of VHC in the Ross group was mainly reflected in patients aged < 6 years at operation.
我们对在本中心接受带瓣同种异体管道（VHC）用于右心室流出道（RVOT）重建的患者进行了回顾性研究。分析了长期预后，并探讨了影响VHC长期耐久性的危险因素。采用Kaplan-Meier生存曲线评估生存率、VHC再次干预的自由度以及VHC功能障碍的自由度。使用多变量Cox比例风险回归模型分析VHC晚期功能障碍的危险因素。本中心共有290例接受VHC进行RVOT重建的患者入组。7例患者早期死亡，均在非Ross组。265例患者随访了85（0.3 - 176.0）个月。6例患者晚期死亡。均在非Ross组。6例患者接受了VHC再次干预。在随访期间，52例患者出现VHC功能障碍。在整个队列中，Ross组VHC功能障碍的自由度高于非Ross组。多变量Cox回归分析显示，年龄<6岁和非Ross手术是VHC功能障碍的独立危险因素。在手术时年龄小于6岁的患者中，Ross组VHC功能障碍的自由度高于非Ross组。然而，在年龄大于6岁的患者中，两组在VHC功能障碍的自由度方面没有显著差异。VHC用于RVOT重建的长期预后令人满意。年龄<6岁和非Ross手术是VHC功能障碍的独立危险因素。Ross组VHC的长期生存率和耐久性优于非Ross组。Ross组VHC长期耐久性的优势主要体现在手术时年龄<6岁的患者中。
