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[狭窄的异种移植带瓣管道的再次手术及球囊扩张术]

[Reoperation and balloon dilatation for stenosed xenograft valved conduits].

作者信息

Kobayashi J, Matsuda H, Nakano S, Shimazaki Y, Kadoba K, Miura T, Ikawa S, Mitsuno M, Takahashi Y, Kawashima Y

机构信息

First Department of Surgery, Osaka University Medical School, Japan.

出版信息

Nihon Kyobu Geka Gakkai Zasshi. 1994 Apr;42(4):551-6.

PMID:8035076
Abstract

Follow-up has been achieved in 41 hospital survivals who received xenograft valved conduits in the pulmonary position. The interval after operation ranged 6 months to 13 years (average 5.2 +/- 3.7 years) (+/- standard deviation). There has been 8 late deaths, 3 of which were sudden. Of the 11 reoperations, 7 underwent graft replacement with no operative death. The actuarial reoperation free survival rate was 73% at 5 years, and 54% at 10 years. There was a significant correlation between the interval after operation (x years) and the pressure gradient across the conduits (y mmHg). (y = 20.7 + 9.7x, r = 0.74, p < 0.001). Balloon dilatation of the conduits was performed in 15 patients. The mean conduit gradient was significantly (p < 0.001) reduced from 85 +/- 29 to 54 +/- 22 mmHg. However, the effect was not satisfactory enough and 4 patients received graft replacement after the balloon dilatation. These results warrant the avoidance of xenograft valved conduits in the pulmonary position, the safety of the graft replacement, and the limitation of the balloon dilatation for the stenosed conduits.

摘要

对41例在肺动脉位置接受异种移植带瓣管道的医院存活患者进行了随访。术后间隔时间为6个月至13年(平均5.2±3.7年)(±标准差)。有8例晚期死亡,其中3例为猝死。在11例再次手术中,7例进行了移植置换,无手术死亡。5年时再次手术-free生存率的精算值为73%,10年时为54%。术后间隔时间(x年)与管道两端压力阶差(y mmHg)之间存在显著相关性(y = 20.7 + 9.7x,r = 0.74,p < 0.001)。15例患者进行了管道球囊扩张。管道平均压力阶差从85±29 mmHg显著(p < 0.001)降至54±22 mmHg。然而,效果不够理想,4例患者在球囊扩张后接受了移植置换。这些结果表明应避免在肺动脉位置使用异种移植带瓣管道,移植置换的安全性以及球囊扩张对狭窄管道的局限性。

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