Oktay Ayla, Arnaz Ahmet, Ayabakan Canan, Sarioglu Tayyar, Yalcinbas Yusuf Kenan
Department of Pediatric Cardiology, Acibadem Bakirkoy Hospital, Istanbul, Turkey.
Department of Cardiovascular Surgery, Acibadem Mehmet Ali Aydinlar University School of Medicine, Istanbul, Turkey.
Pediatr Cardiol. 2024 Aug 22. doi: 10.1007/s00246-024-03624-4.
This study evaluates a novel surgical technique inspired by the hybrid Norwood procedure, which involves ductal graft placement and bilateral pulmonary artery banding. This technique is designed to avoid the high-risk classical Norwood stage 1 operation and to avoid the need for first stage invasive catheter interventions and interstage catheter interventions when ductal stent placement is not feasible in developing countries with limited resources. Between June 2015 and December 2022, 14 patients with hypoplastic left heart syndrome and variants were treated using this procedure at our center. Polytetrafluoroethylene graft was used for ductal graft procedure and polytetrafluoroethylene bands were used for bilateral pulmonary banding. Atrial septectomy was done selectively. Patients with adequate left heart growth underwent biventricular repair and pulmonary debanding. Patients without left heart growth underwent cavopulmonary anastomosis or necessary intermediate surgical revisions. Seven patients out of 14 reached the second stage. Two received biventricular repair, three underwent bidirectional cavopulmonary anastomosis, and two required repeat palliations other than bidirectional cavopulmonary anastomosis. Modifications of the Norwood procedure is an ongoing process due to the complex nature of hypoplastic left heart syndrome and variants. As experience grows, the mortality associated with ductal graft and bilateral pulmonary banding procedure may decrease, making this technique an alternative for centers where classical Norwood operation or hybrid palliation is not possible, especially in developing countries with limited resources. We might predict promising outcomes, especially for patients with hypoplastic left heart complex where biventricular repair is expected.
本研究评估了一种受杂交诺伍德手术启发的新型手术技术，该技术包括放置导管移植物和双侧肺动脉环扎术。此技术旨在避免高风险的经典诺伍德一期手术，以及在资源有限的发展中国家无法进行导管支架置入时避免一期侵入性导管干预和分期导管干预的需求。2015年6月至2022年12月期间，我们中心使用该手术方法治疗了14例左心发育不全综合征及变异型患者。聚四氟乙烯移植物用于导管移植物手术，聚四氟乙烯带用于双侧肺环扎术。选择性地进行房间隔切除术。左心发育良好的患者接受双心室修复和肺动脉解环扎术。左心未发育的患者接受腔肺吻合术或必要的中间手术修正。14例患者中有7例进入第二阶段。2例接受双心室修复，3例接受双向腔肺吻合术，2例需要进行除双向腔肺吻合术之外的重复姑息治疗。由于左心发育不全综合征及变异型的复杂性，诺伍德手术的改良是一个持续的过程。随着经验的积累，与导管移植物和双侧肺环扎术相关的死亡率可能会降低，使该技术成为无法进行经典诺伍德手术或杂交姑息治疗的中心的一种选择，尤其是在资源有限的发展中国家。我们可以预测会有良好的结果，特别是对于预期进行双心室修复的左心发育不全综合征患者。
