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牛颈静脉与带瓣猪导管用于右心室至肺动脉连接的效果比较

Outcomes of Bovine Jugular Vein Versus Porcine Valved Conduits for Right Ventricle to Pulmonary Artery Connection.

作者信息

Temur Bahar, Gokce Ibrahim, Tire Yakup, Ozcan Zeynep Sila, Aydin Selim, Polat Tugcin Bora, Erek Ersin

机构信息

Department of Cardiovascular Surgery, Acibadem Mehmet Ali Aydinlar University School of Medicine, Istanbul, Turkey.

Acibadem Mehmet Ali Aydinlar University School of Medicine, Istanbul, Turkey.

出版信息

Pediatr Cardiol. 2025 May 10. doi: 10.1007/s00246-025-03885-7.

Abstract

Homografts conduits has been the gold standard for right ventricle to pulmonary artery (RV-PA) conduit. Several different types of xenograft valved conduits have been used as an alternative to homografts, due to their limited availability. In this single center, retrospective study, we analyzed the outcomes of patients with bovine jugular vein conduit (Contegra) and porcine valved conduit (Biointegral) in terms of survival and reintervention rate. Between 2012 and 2023, 44 children underwent surgical repair with RV-PA conduits using Contegra (n = 20) or Biointegral (n = 24). Patients with truncus arteriosus and patients who underwent unifocalization and Ross procedures were excluded. The operations in which other RV-PA conduits such as homografts, Gore-Tex grafts with PTFE handmade valved were used, were also excluded from the study. The median age of the patients was 19 (3-60) months and 84% of the patients (n = 37) had a history of previous intervention. Hospital mortality was 4.5% (n = 2). The median length of stay in intensive care unit and hospital was 5 (2-63) and 19 (2-145) days, respectively. 36 of the patients (82%) were followed for a median of 68 (4.8-143.7) months. There was one late death in Contegra group and five late deaths in Biointegral group. Survival analysis revealed that 1, 5, and 10-year survival rates were 100%, 90%, and 90% in Contegra group and 81%, 76.2%, and 33.9% (p = 0.047) in Biointegral group, respectively. During follow-up period, 11 patients (30.5%) needed reintervention (n = 3 in Contegra; n = 8 in Biointegral group). Freedom from reintervention rates were 100%, 94.1%, and 47.1% at 1, 5, and 10 years in Contegra group and 100% and 63.3% at 1 and 5 years in Biointegral group, respectively (p = 0.024). In this study, the outcomes of Contegra conduits were statistically significantly better than Biointegral conduits. Contegra is still the most valuable alternative to homografts. We believe that the choice of conduit in the first surgery is an important decision that directly affects survival and re-intervention rates.

摘要

同种异体移植管道一直是右心室至肺动脉(RV-PA)管道的金标准。由于同种异体移植的可用性有限,几种不同类型的异种带瓣管道已被用作替代方案。在这项单中心回顾性研究中,我们分析了使用牛颈静脉管道(Contegra)和猪带瓣管道(Biointegral)的患者在生存和再次干预率方面的结果。2012年至2023年期间,44名儿童接受了使用Contegra(n = 20)或Biointegral(n = 24)进行RV-PA管道的手术修复。患有动脉干的患者以及接受了单灶化和Ross手术的患者被排除在外。使用其他RV-PA管道(如同种异体移植、带有PTFE手工制作瓣膜的Gore-Tex移植物)的手术也被排除在研究之外。患者的中位年龄为19(3 - 60)个月,84%的患者(n = 37)有既往干预史。医院死亡率为4.5%(n = 2)。重症监护病房和医院的中位住院时间分别为5(2 - 63)天和19(2 - 145)天。36名患者(82%)的中位随访时间为68(4.8 - 143.7)个月。Contegra组有1例晚期死亡,Biointegral组有5例晚期死亡。生存分析显示,Contegra组1年、5年和10年生存率分别为100%、90%和90%,Biointegral组分别为81%、76.2%和33.9%(p = 0.047)。在随访期间,11名患者(30.5%)需要再次干预(Contegra组n = 3;Biointegral组n = 8)。Contegra组1年、5年和10年无再次干预率分别为100%、94.1%和47.1%,Biointegral组1年和5年分别为100%和63.3%(p = 0.024)。在本研究中,Contegra管道的结果在统计学上显著优于Biointegral管道。Contegra仍然是同种异体移植最有价值的替代方案。我们认为首次手术中管道的选择是一个直接影响生存和再次干预率的重要决定。

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