Zhang Shuai, Ma Jianrui, Liu Xiang, Tan Tong, Xie Wen, Liu Haozhong, Wang Huimin, Qiu Hailong, Wen Shusheng, Chen Jimei, Zhuang Jian, Yuan Haiyun, Cen Jianzheng
Guangdong Provincial Key Laboratory of South China Structural Heart Disease, 510080 Guangzhou, Guangdong, China.
Department of Cardiovascular Surgery, Guangdong Cardiovascular Institute, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, 510080 Guangzhou, Guangdong, China.
Rev Cardiovasc Med. 2024 Mar 4;25(3):84. doi: 10.31083/j.rcm2503084. eCollection 2024 Mar.
Both systemic-to-pulmonary shunt and right ventricle-pulmonary artery (RV-PA) connection are extensively applied to initially rehabilitate the pulmonary artery in pulmonary atresia with the ventricle septal defect (PA/VSD). However, which of these options is the most ideal for promoting pulmonary artery development and improving outcomes remains controversial.
A total of 109 PA/VSD patients undergoing initial rehabilitative surgery at Guangdong Provincial People's Hospital from 2010 to 2020 were enrolled in this study. A series of clinical data were collected to compare the perioperative and postoperative outcomes between systemic-to-pulmonary and RV-PA connection.
The mean duration of follow-up was 61.1 months in the systemic-to-pulmonary shunt group and 70.3 months in the RV-PA connection group ( 0.05). The RV-PA connection technique resulted in a significantly higher , lower red blood cells (RBC), lower hemoglobin, and lower hematocrit (Hct) ( 0.05). The cumulative incidence curve estimated a cumulative complete repair rate of 56 7% after 5 years in the RV-PA connection group, significantly higher than 36 7% after 5 years in the systemic-to-pulmonary shunt group ( 0.05). The Kaplan-Meier curve revealed a similar estimated survival rate between the two groups ( = 0.73). The RV-PA connection was identified as an independent predictor for complete repair in the multivariable analysis (HR = 2.348, 95% CI = 1.131-4.873).
The RV-PA connection is a more ideal initial rehabilitative technique than systemic-to-pulmonary shunt in treating PA/VSD as a consequence of comparable probability of survival but improved definitive complete repair rate.
体肺分流术和右心室-肺动脉（RV-PA）连接术在肺动脉闭锁合并室间隔缺损（PA/VSD）的初始肺动脉修复中均被广泛应用。然而，对于促进肺动脉发育和改善预后而言，哪种术式最为理想仍存在争议。
本研究纳入了2010年至2020年期间在广东省人民医院接受初次修复手术的109例PA/VSD患者。收集了一系列临床数据，以比较体肺分流术和RV-PA连接术的围手术期及术后结局。
体肺分流术组的平均随访时间为61.1个月，RV-PA连接术组为70.3个月（P>0.05）。RV-PA连接术导致更高的[具体指标未给出]、更低的红细胞（RBC）、更低的血红蛋白和更低的血细胞比容（Hct）（P<0.05）。累积发病率曲线估计，RV-PA连接术组5年后的累积完全修复率为56.7%，显著高于体肺分流术组5年后的36.7%（P<0.05）。Kaplan-Meier曲线显示两组的估计生存率相似（P = 0.73）。在多变量分析中，RV-PA连接术被确定为完全修复的独立预测因素（HR = 2.348，95%CI = 1.131 - 4.873）。
在治疗PA/VSD方面，RV-PA连接术是比体肺分流术更理想的初始修复技术，因为两者生存率相当，但确定性完全修复率更高。
