Xing Pengchao,Chao Cong,Wang Benzhen,et al.Comparative study of right atrial appendage replacing pulmonary valve versus traditional transannular patching for tetralogy of Fallot during right ventricular outflow tract reconstruction[J].Journal of Clinical Pediatric Surgery,,():823-829.[doi:10.3760/cma.j.cn101785-202505052-004]
Comparative study of right atrial appendage replacing pulmonary valve versus traditional transannular patching for tetralogy of Fallot during right ventricular outflow tract reconstruction
- Keywords:
- Atrial Appendage; Pulmonary Valve; Heart Diseases; Ventricular Dysfunction; Right; Anesthesia; Cardiac Procedures; Child
- Abstract:
- Objective To compare the clinical efficacies of autologous right atrial appendage (RAA) reconstruction of pulmonary valve versus traditional transannular patching in preventing postoperative pulmonary valve regurgitation during radical surgery for tetralogy of Fallot (TOF). Methods From February 2020 to March 2025, retrospective analysis was performed for 24 TOF children requiring transannular patching.Based upon the reconstructing mode of right ventricular outflow tract, they were assigned into two groups of RAA (autologous RAA substituting pulmonary valve) and traditional transannular patching.Preoperative data, intraoperative parameters and postoperative follow-up data were compared between two groups. Results RAA Group (n=9): 5 boys and 4 girls with a surgical age of (5.6±2.9) month; body weight (6.9±2.2) kg; preoperative oxygen saturation (87.2±2.0)%.Traditional transannular patching (n=15): 9 boys and 6 girls with a surgical age of (5.6±2.1) month; body weight (7.5±1.6) kg; preoperative oxygen saturation (88.4±2.2)%.No significant inter-group differences existed in surgical age, body weight or preoperative oxygen saturation (P>0.05).Intraoperative parameters with statistical significance: Operative duration: (208.7±16.2) vs. (165.4±13.7) min, t=6.988, P < 0.001; aortic cross-clamp time: (104.2±7.6) vs. (83.2±10.8) min; cardiopulmonary bypass time: (139.4±12.8) vs. (111.9±9.5) min; Postoperative outcomes without significant differences: intensive care unit (ICU) stay: 4.0(4.0, 5.0) vs. 4.0(3.0, 4.0) day; ventilator duration: 20.0(15.0, 36.5) vs. 13.0(10.0, 20.0) h; hospitalization stay: (14.6±2.0) vs. (13.8±1.7) day; incidence of arrhythmia: 2/9(22.2%) vs. 4/15 (26.7%) (P>0.05 for all); Pulmonary valve regurgitation during follow-ups (up to 12 month): Right atrial appendage group (5 cases followed for 12 months): no regurgitation (n=1, 11%), mild regurgitation (n=5, 55%), trivial regurgitation (n=3, 33%); no moderate or severe regurgitation.Traditional patch group (all followed for 12 month): mild regurgitation (n=9, 60%), moderate regurgitation (n=6, 40%); significant difference (P < 0.05).In terms of postoperative pulmonary valve pressure gradient, no statistically significant inter-group differences existed at Month 1 [(24.0±1.9) vs. (23.5±1.0) mmHg, t=-0.161, P>0.05], Month 6 [(25.8±1.7) vs. (22.9±0.8) mmHg]or Month 12 [(25.8±1.3) vs. (23.4±0.7) mmHg](P > 0.05). Conclusions Replacing pulmonary valve with RAA is both safe and effective with the advantages of convenient autologous tissue harvesting, no need for anticoagulation and growth potential.Despite a slightly longer operative duration, its postoperative recovery is comparable to traditional transannular patching.According to short-to-medium-term follow-up results, it has decent efficacy in preventing pulmonary valve regurgitation.
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Memo
收稿日期:2025-5-30。
基金项目:国家自然科学基金(82370308)
通讯作者:陈瑞, Email: chenrui421@126.com