Lyapin Anton Alexandrovich, Lyapina Irina Nikolaevna, Rumiantseva Alexandra Alexandrovna, Tarasov Roman Sergeevich
Laboratory of X-Ray Endovascular and Reconstructive Cardiovascular Surgery, Department of Cardiovascular Surgery, Federal State Budgetary Institution "Research Institute for Complex Issues of Cardiovascular Diseases", Blvd. Named After Academician L.S. Barbarasha, 6, 650002 Kemerovo, Russia.
J Cardiovasc Dev Dis. 2024 Dec 11;11(12):398. doi: 10.3390/jcdd11120398.
Evaluation of the short-term and long-term results of a phased correction of the tetralogy of Fallot (ToF) with stenting of the right ventricular outflow tract (RVOT) in comparison with a one-stage total correction (TC) of the defect.
Two groups of patients with classical ToF were formed. Group 1 (n = 25; median age = 72 days) was initially represented by children with ToF with a more severe clinical status (median weight = 3.6 kg, with more pronounced cyanosis and with comorbidities). The children of group 1 underwent the first stage of RVOT stenting and the second stage of TC of ToF. Group 2 (n = 25) was represented by older patients, with a higher body weight and SpO2 level, and they underwent a single-stage TC of the defect.
The application of a step-by-step ToF correction approach with RVOT stenting in low-weight newborns with severe hypoxemia demonstrated an equivalent effect on SpO2 dynamics-reverse remodeling of the heart-when compared with a less severe cohort of patients who underwent simultaneous TC of classical ToF. After RVOT stenting in children from group 1, the median SpO2 increased from 80% to 94.5%, the median Z value of the pulmonary artery trunk decreased from -3.46 mm to -2.54 mm, and the median index of end-diastolic volume of the left ventricle decreased from 23.07 mm/m to 57.6 mL/m. TC of ToF in children from group 1 with a phased strategy of correction of the defect was no less successful than in children who underwent simultaneous TC. In the long-term follow-up period after TC of ToF, children from both groups, who were obviously unequal in their initial status, were practically comparable in clinical characteristics, exhibiting features of cardiac remodeling and achieving endpoints. And there were no significant differences between the two groups in the frequency of reaching the endpoints such as re-operations, cerebrovascular events, and death during the annual, three-year, and five-year follow-up period.
The strategy of RVOT stenting followed by TC of ToF in a severe group of children demonstrated comparable results compared with the results of simultaneous TC of ToF in a more stable group of patients during the in-hospital, annual, three-year, and five-year follow-up periods.
评估法洛四联症（ToF）分阶段矫正术联合右心室流出道（RVOT）支架置入术的短期和长期效果，并与该缺损的一期完全矫正术（TC）进行比较。
将两组患有典型ToF的患者分组。第1组（n = 25；中位年龄 = 72天）最初为临床状况更严重的ToF患儿（中位体重 = 3.6 kg，发绀更明显且伴有合并症）。第1组患儿接受了RVOT支架置入术的第一阶段和ToF矫正术的第二阶段。第2组（n = 25）为年龄较大、体重较高且SpO2水平较高的患者，他们接受了缺损的一期TC。
与接受经典ToF同期TC的病情较轻队列相比，在低体重、严重低氧血症的新生儿中采用分步ToF矫正联合RVOT支架置入术对SpO2动态变化——心脏逆向重塑——显示出同等效果。第1组患儿RVOT支架置入术后，中位SpO2从80%升至94.5%，肺动脉干的中位Z值从 -3.46 mm降至 -2.54 mm，左心室舒张末期容积指数从中位值23.07 mm/m降至57.6 mL/m。采用分阶段矫正策略的第1组患儿的ToF矫正术与接受同期TC的患儿相比同样成功。在ToF矫正术后的长期随访期内，两组初始状况明显不同的患儿在临床特征方面实际相当，均表现出心脏重塑特征并达到终点。在年度、三年和五年随访期内，两组在再次手术、脑血管事件和死亡等终点事件发生频率方面无显著差异。
在住院期间、年度、三年和五年随访期内，重症患儿组采用RVOT支架置入术随后进行ToF矫正术的策略与病情更稳定患儿组ToF同期矫正术的结果相当。
