Zhu Yifan,Jiang Qi,Chen Dian,et al.Middle-term follow-up results of right ventricular outflow tract with valve tube reconstruction[J].Journal of Clinical Pediatric Surgery,,():841-845.[doi:10.3760/cma.j.cn101785-202505053-007]
Middle-term follow-up results of right ventricular outflow tract with valve tube reconstruction
- Keywords:
- Bovine Jugular Veins; Polytetrafluoroethylene; Heart Diseases; Ventricular Dysfunction; Right; Anesthesia; Cardiac Procedures; Child
- Abstract:
- Objective This study aimed to evaluate the middle-term efficacy and durability of valved conduits for reconstructingright ventricular outflow tract (RVOT) of congenital heart disease. Methods This single-center retrospective study included 515 children undergoing RVOT reconstruction between 2018 and 2024.Of these, 459 received hand-sewn trileaflet expanded polytetrafluoroethylene (ePTFE) valved conduits while 56 received bovine jugular vein (BJV) conduits.Conduit size was selected based upon patient Z-score and body surface area.They were stratified by conduit diameter: < 14 mm (n=25), 14-20 mm (n=285), and ≥22 mm (n=205).Major outcome measures included survival rate, re-intervention rate (catheter replacement/internal medicine intervention) and avoidance of reoperation rate.Secondary outcome measures were composed of degree of pulmonary artery stenosis (cardiac ultrasound evaluation, flow velocity ≥ 3.5 m/s as significant stenosis), degree of pulmonary artery reflux (grading: negative/mild, mild/mild moderate, moderate & severe). Results This cohort comprised 515 children with a mean follow-up period of 2.3 year.The overall 5-year survival rate was 97.3% with a mortality rate of 1.7%(9/515).No death was conduit-related.The overall reintervention rate was 6.6% (28 conduit replacements plus 6 transcatheter interventions).ePTFE valved conduits demonstrated superior performance with a 5-year freedom from reoperation rate of 95.6% versus 54.2% for BJV conduits.Echocardiographic follow-ups revealed that larger conduits (≥22 mm) had the lowest freedom from reoperation with a median time to reoperation of 2.8 years (vs.1.5 years for smaller conduits) and the highest 5-year freedom from pulmonary stenosis (84.5%). Conclusions Valved conduits provide excellent mid-term outcomes for RVOT reconstruction.Using BJV conduits is associated with an elevated risk of reoperation.Larger conduit sizes offer more durable valvular function.
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Memo
收稿日期:2025-5-30。
基金项目:国家自然科学基金(82370307，82400367)
通讯作者:张海波，Email: zhanghaibosh@126.com