Touré Taher, Roubertie François, Bridier Tiphaine, Foulgoc Hélène, Thambo Jean-Benoît, Ouattara Alexandre, Tafer Nadir
CHU Sainte-Justine, Department of Anesthesia, 3175 Chemin de La Côte-Sainte-Catherine, Montreal, Québec, H3T 1C5, Canada.
CHU Bordeaux, Department of Anaesthesia and Critical Care, Magellan Medico-Surgical Centre, F-33000, Bordeaux, France.
Int J Cardiol Congenit Heart Dis. 2022 Mar 23;8:100360. doi: 10.1016/j.ijcchd.2022.100360. eCollection 2022 Jun.
Patients undergoing complete repair of tetralogy of Fallot generally have an excellent prognosis. Unfortunately, pulmonary valve reconstruction with a transannular patch is generally required. Resulting pulmonary regurgitation is associated with late right ventricular dysfunction and morbidity. Early pulmonary regurgitation may also be poorly tolerated. This study compares immediate outcomes of non-valved transannular patch repair (NV-TAP) to a valve-sparing (V-Sp) approach.
67 patients, with tetralogy of Fallot and severe pulmonary annular hypoplasia underwent complete repair between 2010 and 2018.23 patients had a NV-TAP repair while a V-Sp technique was used in 44 patients. Mortality, length of stay in the intensive care unit and hospital, use of inotropes, duration of mechanical ventilation, use and duration of dialysis, chest drainage duration, reinterventions, and postoperative complications were compared. Immediate outcomes were assessed by biological data and postoperative echocardiography.
ICU stay was shorter in the V-Sp group (5 days vs 8 days, p = 0.009). At postoperative day 1, Vasoactive Inotropic Score and mean dosage of adrenaline were significantly lower in the V-Sp group. Duration of inotrope use was significantly shorter. Hospital stay, mechanical ventilation, and chest drainage duration, the incidence and duration of dialysis all showed a trend towards being lower in the V-Sp group. Surgical complications were similar despite longer cardiopulmonary bypass and aortic cross-clamp durations.
Repair of the native pulmonary valve by a V-Sp technique reduces length of stay in the ICU and the use of inotropic agents in the immediate post-operative period.
接受法洛四联症完全修复术的患者通常预后良好。不幸的是，一般需要使用跨环补片进行肺动脉瓣重建。由此导致的肺动脉反流与晚期右心室功能障碍和发病率相关。早期肺动脉反流也可能耐受性较差。本研究比较了无瓣膜跨环补片修复术（NV-TAP）与保留瓣膜（V-Sp）方法的近期疗效。
2010年至2018年间，67例患有法洛四联症且严重肺动脉环发育不全的患者接受了完全修复术。23例患者接受了NV-TAP修复术，44例患者采用了V-Sp技术。比较了死亡率、重症监护病房和医院的住院时间、血管活性药物的使用、机械通气时间、透析的使用和持续时间、胸腔引流时间、再次干预以及术后并发症。通过生物学数据和术后超声心动图评估近期疗效。
V-Sp组的重症监护病房住院时间较短（5天对8天，p = 0.009）。术后第1天，V-Sp组的血管活性药物评分和肾上腺素平均剂量显著较低。血管活性药物的使用时间显著较短。V-Sp组的住院时间、机械通气时间和胸腔引流时间、透析的发生率和持续时间均呈降低趋势。尽管体外循环和主动脉阻断时间较长，但手术并发症相似。
采用V-Sp技术修复天然肺动脉瓣可缩短重症监护病房住院时间，并减少术后早期血管活性药物的使用。
