Tuncer Osman Nuri, Akhundova Mahsati, Doğan Eser, Atay Yüksel
Department of Cardiovascular Surgery, Ege University Faculty of Medicine, İzmir, Türkiye.
Department of Cardiovascular Surgery, İzmir Tınaztepe University Private Buca Hospital, İzmir, Türkiye.
Turk Gogus Kalp Damar Cerrahisi Derg. 2025 Jul 21;33(3):272-278. doi: 10.5606/tgkdc.dergisi.2025.27057. eCollection 2025 Jul.
This study aims to evaluate the long-term outcomes of patients undergoing right ventricle-to-pulmonary artery reconstruction with valved homografts.
A total of 106 patients (49 males, 57 females; median age: 5 years; range, 2 to 49 years) who underwent right ventricle-to-pulmonary artery reconstruction between January 2002 and January 2024 were retrospectively analyzed. The study utilized cryopreserved homografts and surgical procedures were conducted under moderate hypothermic conditions using cardiopulmonary bypass. Homograft failure was defined as the need for reintervention or replacement. The primary outcome measures were overall survival, freedom from conduit replacement rate, and freedom from any required reinterventions rate.
The median follow-up was 7 years. The overall survival rate was 92.5%, with early mortality primarily due to low cardiac output. Freedom from reintervention rates were 90.8%, 84.8%, and 76.3% at three, five, and 10 years, respectively. Thirteen patients required conduit replacement, with pulmonary homografts showing improved durability. Risk factors for homograft failure included pulmonary valve regurgitation treatment, lower patient weight, younger age, and female sex.
This study highlights the excellent survival and durability of valved homografts in cardiac reconstruction, with implications for patient management and surgical decision-making in complex congenital heart disease procedures.
本研究旨在评估接受带瓣同种异体移植物右心室至肺动脉重建术患者的长期预后。
回顾性分析2002年1月至2024年1月期间接受右心室至肺动脉重建术的106例患者（男性49例，女性57例；中位年龄：5岁；范围2至49岁）。本研究使用了低温保存的同种异体移植物，手术在中度低温条件下使用体外循环进行。同种异体移植物失败定义为需要再次干预或置换。主要结局指标为总生存率、无管道置换率和无任何所需再次干预率。
中位随访时间为7年。总生存率为92.5%，早期死亡率主要归因于心输出量低。在3年、5年和10年时，无再次干预率分别为90.8%、84.8%和76.3%。13例患者需要进行管道置换，肺动脉同种异体移植物显示出更好的耐久性。同种异体移植物失败的危险因素包括肺动脉瓣反流治疗、患者体重较低、年龄较小和女性性别。
本研究强调了带瓣同种异体移植物在心脏重建中的良好生存率和耐久性，对复杂先天性心脏病手术中的患者管理和手术决策具有重要意义。
