Cho Han, Sohn Suk Ho, Choi Jae Woong, Hwang Ho Young, Kim Kyung Hwan, Na Kwon Joong, Kang Chang Hyun
Department of Thoracic and Cardiovascular Surgery, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Republic of Korea.
Interdiscip Cardiovasc Thorac Surg. 2024 Dec 3;39(6). doi: 10.1093/icvts/ivae194.
This study compared the mid-term patency of expanded polytetrafluoroethylene grafts without rings versus that of bovine pericardial conduits used for superior vena cava reconstruction for various thoracic diseases.
Among 80 patients who underwent superior vena cava resection and reconstruction between 2009 and 2023 at our institution, 31 patients who received polytetrafluoroethylene grafts without rings (Polytetrafluoroethylene group) and 28 patients who received bovine pericardial conduits (Bovine group) were enrolled. Median follow-up durations were 19.5 and 64.6 months in the Polytetrafluoroethylene and Bovine groups, respectively. Primary outcome was midterm graft patency rate, and secondary outcomes were early and midterm clinical outcomes, including all-cause mortality and superior vena cava reintervention.
Operative mortality was 1.7%. Cumulative incidence of all-cause mortality was not significantly different between the groups. Graft occlusion was detected in 22 patients. Cumulative incidence of graft occlusion was 24.2%, 36.4%, 42.4%, 48.5% and 60.6% at 1 month, 3 months, 6 months, 1 year and 2 years, respectively, in the Bovine group, whereas no graft occlusion was observed in the Polytetrafluoroethylene group (P = 0.007). Although the incidence of graft occlusion was higher in the Bovine group, cumulative incidence of reintervention was not significantly different between the groups (0.0% vs 3.0% in Polytetrafluoroethylene vs Bovine groups at 1 year, P = 0.406). Multivariate analysis demonstrated that bovine pericardial conduit (polytetrafluoroethylene graft as reference) and left brachiocephalic vein reconstruction (right brachiocephalic vein reconstruction as reference) were significant risk factors for graft occlusion.
In superior vena cava reconstruction, polytetrafluoroethylene grafts without rings were superior to bovine pericardial conduits in terms of midterm graft patency.
本研究比较了无环膨体聚四氟乙烯移植物与用于各种胸科疾病上腔静脉重建的牛心包管道的中期通畅率。
在2009年至2023年期间于我院接受上腔静脉切除和重建的80例患者中，纳入了31例接受无环聚四氟乙烯移植物的患者（聚四氟乙烯组）和28例接受牛心包管道的患者（牛心包组）。聚四氟乙烯组和牛心包组的中位随访时间分别为19.5个月和64.6个月。主要结局是中期移植物通畅率，次要结局是早期和中期临床结局，包括全因死亡率和上腔静脉再次干预。
手术死亡率为1.7%。两组间全因死亡率的累积发生率无显著差异。在22例患者中检测到移植物闭塞。牛心包组在1个月、3个月、6个月、1年和2年时移植物闭塞的累积发生率分别为24.2%、36.4%、42.4%、48.5%和60.6%，而聚四氟乙烯组未观察到移植物闭塞（P = 0.007）。尽管牛心包组移植物闭塞的发生率较高，但两组间再次干预的累积发生率无显著差异（聚四氟乙烯组与牛心包组在1年时分别为0.0%和3.0%，P = 0.406）。多因素分析表明，牛心包管道（以聚四氟乙烯移植物为对照）和左头臂静脉重建（以右头臂静脉重建为对照）是移植物闭塞的显著危险因素。
在上腔静脉重建中，无环聚四氟乙烯移植物在中期移植物通畅方面优于牛心包管道。
