Lacour-Gayet F, Serraf A, Komiya T, Sousa-Uva M, Bruniaux J, Touchot A, Roux D, Neuville P, Planché C
Department of Pediatric Cardiac Surgery, Marie Lannelongue Hospital, Paris, France.
J Thorac Cardiovasc Surg. 1996 Apr;111(4):849-56. doi: 10.1016/s0022-5223(96)70346-x.
Fifty-six consecutive patients underwent total correction of truncus arteriosus. Median age at repair was 41 days, with a range of 2 days to 8 months. In 71% the operation was done in the first 2 months of life. Nine patients had complex forms of truncus and 11 patients had aortic insufficiency. The truncal aortic root was transected, which provides a clear exposure of the coronary ostia. The aorta was reconstructed by direct end-to-end anastomosis, and the truncal valve was preserved in every case. Several different techniques were used for pulmonary reconstruction, including three types of anatomic reconstruction of the pulmonary valve with a trisigmoid leaflet system and two types of nonanatomic reconstruction. The anatomic techniques included use of 33 Dacron valved conduits, eight homograft valved conduits, and one porcine aortic root bioprosthesis. The nonanatomic reconstructions included direct anastomosis to the right ventricle in nine patients and insertion of autologous pericardial valved conduits in five. The hospital mortality was 16% (9/56; 95% confidence limits, 2% to 30%). Multivariate analysis outlines two independent incremental risk factors for hospital death: nonanatomic pulmonary valve reconstruction techniques and age younger than 1 month. The hospital mortality was 7.1% in the group with anatomic pulmonary valve reconstruction versus 43% in the group with nonanatomic pulmonary valve reconstruction (p = 0.015). The hospital mortality was 5.7% in those older than 1 month versus 33% in those younger than 1 month of age (p = 0.04). There were two late deaths. The actuarial freedom from reoperation and angioplasty at 7 years was 100% for patients receiving pericardial conduits, 80% for those undergoing direct anastomosis, 77% for those receiving Dacron conduits, and only 43% for those receiving homografts (p = 0.02). In conclusion, anatomic reconstruction of the pulmonary valve seems important at the time of the operation, age younger than 1 month remains an incremental risk factor, and the truncal valve can be preserved.
56例连续性患者接受了共同动脉干的完全矫正术。修复时的中位年龄为41天，范围为2天至8个月。71%的手术在出生后的前2个月内进行。9例患者有复杂形式的共同动脉干，11例患者有主动脉瓣关闭不全。将共同动脉干的主动脉根部横断，这能清晰暴露冠状动脉口。通过直接端端吻合重建主动脉，并且在每种情况下均保留共同动脉干瓣膜。采用了几种不同的技术进行肺动脉重建，包括三种带三尖瓣叶系统的肺动脉瓣解剖重建类型和两种非解剖重建类型。解剖技术包括使用33个涤纶带瓣管道、8个同种异体带瓣管道和1个猪主动脉根部生物假体。非解剖重建包括9例患者直接与右心室吻合以及5例患者植入自体心包带瓣管道。医院死亡率为16%（9/56；95%置信区间，2%至30%）。多因素分析确定了两个独立的医院死亡增加危险因素：非解剖性肺动脉瓣重建技术和年龄小于1个月。解剖性肺动脉瓣重建组的医院死亡率为7.1%，而非解剖性肺动脉瓣重建组为43%（p = 0.015）。年龄大于1个月者的医院死亡率为5.7%，而年龄小于1个月者为33%（p = 0.04）。有2例晚期死亡。接受心包管道的患者7年时免于再次手术和血管成形术的精算生存率为100%，接受直接吻合的患者为80%，接受涤纶管道的患者为77%，而接受同种异体管道的患者仅为43%（p = 0.02）。总之，手术时肺动脉瓣的解剖重建似乎很重要，年龄小于1个月仍然是一个增加的危险因素，并且共同动脉干瓣膜可以保留。
