Cerfolio R J, Danielson G K, Warnes C A, Puga F J, Schaff H V, Anderson B J, Ilstrup D M
Division of Thoracic and Cardiovascular Surgery, Mayo Clinic/Foundation, Rochester, MN 55905, USA.
J Thorac Cardiovasc Surg. 1995 Nov;110(5):1359-66; discussion 1366-8. doi: 10.1016/S0022-5223(95)70059-5.
Between May 1983 and March 1, 1995, 50 patients had replacement of an obstructed pulmonary ventricle-pulmonary artery conduit with an autologous tissue reconstruction in which a prosthetic roof was placed over the fibrous tissue bed of the explanted conduit. The roof was constructed with xenograft pericardium (most recently) (n = 42), homograft dura mater (n = 5), or Dacron fabric (n = 3). Patient ages ranged from 5 to 34 years (median 16 years). The explanted conduits were Hancock conduits (n = 33), Tascon conduits (n = 6), homograft (n = 4), Dacron tube (n = 3), and others (n = 4). Preoperative maximum systolic gradients ranged from 44 to 144 mm Hg (median 78 mm Hg). Thirty-seven concomitant cardiac procedures were done in 29 patients. When a valve was necessary (n = 15), it was possible to place a large-sized valve in the autologous tissue reconstructions (range 22 to 29 mm, median 26 mm). Cardiopulmonary bypass times ranged from 34 to 223 minutes (median 84 minutes), and aortic crossclamp times ranged from 0 (in 32 patients) to 109 minutes (median 0 minutes). Intraoperative postrepair peak systolic gradients from pulmonary ventricle to pulmonary artery ranged from 0 to 33 mm Hg (median 13 mm Hg). There was one early death (2%) in a patient who had additional cardiac procedures. Follow-up was complete in all patients and ranged from 1 month to 11.8 years (median 7.5 years). There were two sudden late deaths: conduits in both were known to be free from obstruction. Forty-four of the 47 surviving patients had evaluation of the gradient by echocardiography or cardiac catheterization 1 month to 11 years (median 7 years) after operation. The gradients ranged from 5 to 45 mm Hg (median 20 mm Hg). None of the conduits developed an obstructive peel, valve obstruction, or valve incompetence. At 10 years, the freedom from reoperation for conduit obstruction was 100%, and freedom from reoperation for any cause was 81%. This technique simplifies conduit replacement, allows for a generous-sized outflow tract, has a low risk, and yields late results that appear superior to those of cryopreserved homografts or other types of extracardiac conduits.
1983年5月至1995年3月1日期间，50例患者接受了自体组织重建术，以替换阻塞的肺动脉心室-肺动脉导管，其中在取出导管的纤维组织床上放置了人工补片。补片采用异种心包（最近）（n = 42）、同种硬脑膜（n = 5）或涤纶织物（n = 3）构建。患者年龄从5岁至34岁不等（中位数16岁）。取出的导管包括汉考克导管（n = 33）、塔斯康导管（n = 6）、同种移植物（n = 4）、涤纶管（n = 3）和其他（n = 4）。术前最大收缩期压差范围为44至144 mmHg（中位数78 mmHg）。29例患者同时进行了37项心脏手术。当需要瓣膜时（n = 15），在自体组织重建中可以放置大型瓣膜（范围22至29 mm，中位数26 mm）。体外循环时间范围为34至223分钟（中位数84分钟），主动脉阻断时间范围为0（32例患者）至109分钟（中位数0分钟）。术中修复后从肺动脉心室到肺动脉的收缩期峰值压差范围为0至33 mmHg（中位数13 mmHg）。1例进行了额外心脏手术的患者早期死亡（2%）。所有患者均完成随访，随访时间从1个月至11.8年不等（中位数7.5年）。有2例晚期猝死：两者的导管均无阻塞。47例存活患者中的44例在术后1个月至11年（中位数7年）通过超声心动图或心导管检查评估了压差。压差范围为5至45 mmHg（中位数20 mmHg）。没有导管出现阻塞性剥离、瓣膜阻塞或瓣膜功能不全。10年时，因导管阻塞再次手术的无事件生存率为100%，因任何原因再次手术的无事件生存率为81%。该技术简化了导管置换，可提供宽敞的流出道，风险低，且远期效果似乎优于冷冻保存的同种移植物或其他类型的心外导管。
