Department of Pediatric Cardiac Surgery, National Cerebral and Cardiovascular Center, Osaka, Japan.
Department of Cardiovascular Surgery, Osaka University Graduate School of Medicine, Osaka, Japan.
Eur J Cardiothorac Surg. 2024 Nov 4;66(5). doi: 10.1093/ejcts/ezae403.
The impact of residual pulmonary stenosis (rPS) or right ventricular (RV) outflow tract obstruction on prognosis after surgical pulmonary valve insertion) in repaired tetralogy of Fallot patients with pulmonary regurgitation (PR) remains controversial. rPS assessment is partially dependent on RV contractility. We investigated the impact of rPS according to RV ejection fraction (RVEF).
In this multicentre, retrospective study, 117 repaired tetralogy of Fallot patients who underwent surgical pulmonary valve insertion for more than moderate PR between 2003 and 2021 were examined. Regarding rPS, the threshold for PR with rPS (PSR) and PR was 25 mmHg. For RVEF, the threshold for preserved RVEF (pEF) and reduced RVEF (rEF) was 40%. The patients were divided into 4 groups: patients with PR and pEF (PR-pEF) (n = 48), those with PR and rEF (PR-rEF) (n = 44), those with PSR and pEF (PSR-pEF) (n = 16), and those with PSR and rEF (PSR-rEF) (n = 9). Clinical parameters, postoperative adverse event rates and their associations were studied.
The 5-year freedom from adverse cardiovascular events was the highest in the PSR-pEF and the lowest in the PSR-rEF groups. The PSR-rEF group had the highest RV end-diastolic pressure (RVEDP) (12 ± 2.2 mmHg) (P = 0.006). From multivariable analysis, RVEDP was associated with postoperative adverse events (P = 0.016). RVEDP > 8 mmHg was associated with a lower freedom from adverse events.
The freedom from adverse events was the lowest in the PSR-rEF group, with the highest RVEDP, suggesting RV systolic and diastolic dysfunction. Reduced RVEF may mask the intrinsic degree of residual stenosis, delay surgical pulmonary valve insertion timing and increase adverse events.
在伴有肺动脉瓣反流（PR）的法洛四联症（TOF）患者中，残余肺动脉瓣狭窄（rPS）或右心室流出道梗阻（RVOT）对术后预后的影响仍存在争议。rPS 的评估部分依赖于 RV 收缩力。我们根据右心室射血分数（RVEF）来研究 rPS 的影响。
在这项多中心回顾性研究中，对 2003 年至 2021 年间因中重度 PR 而行外科肺动脉瓣置换术的 117 例 TOF 患者进行了检查。对于 rPS，存在 rPS 的 PR 阈值（PSR）和 PR 阈值为 25mmHg。对于 RVEF，保留 RVEF（pEF）和降低 RVEF（rEF）的阈值分别为 40%。患者被分为 4 组：PR 伴 pEF（PR-pEF）（n=48）、PR 伴 rEF（PR-rEF）（n=44）、PSR 伴 pEF（PSR-pEF）（n=16）和 PSR 伴 rEF（PSR-rEF）（n=9）。研究了临床参数、术后不良事件发生率及其相关性。
PSR-pEF 组的 5 年无不良心血管事件生存率最高，PSR-rEF 组最低。PSR-rEF 组的 RV 舒张末期压（RVEDP）最高（12±2.2mmHg）（P=0.006）。多变量分析显示，RVEDP 与术后不良事件相关（P=0.016）。RVEDP>8mmHg 与不良事件生存率降低相关。
PSR-rEF 组的不良事件生存率最低，RVEDP 最高，提示 RV 收缩和舒张功能障碍。降低的 RVEF 可能掩盖了残余狭窄的固有程度，延迟外科肺动脉瓣置换术的时机并增加不良事件的发生。
