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,2025,(09):841-845.[doi:10.3760/cma.j.cn101785-202505053-007]
右心室流出道带瓣管道重建的中期随访结果
- Title:
- 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
- 摘要:
- 目的 初步评估带瓣管道在先天性心脏病右心室流出道(right ventricular outflow tract, RVOT)重建术后的中期疗效与耐久性。方法 本研究为单中心回顾性研究，纳入上海儿童医学中心2018-2024年515例RVOT重建患儿，其中459例采用了手工缝制三瓣的聚四氟乙烯(expanded polytetrafluoroethylene, ePTFE)管道，56例采用牛颈静脉(Bovine jugular vein, BJV)管道。基于患儿Z值及体表面积选择合适的管道尺寸，按照管道直径大小分为：＜14 mm 25例，14~20 mm 285例，≥22 mm 205例。主要结局指标：生存率、再干预率(管道置换/内科介入)、免于再手术率；次要结局指标：肺动脉狭窄程度(心超评估，流速≥3.5 m/s为显著狭窄)、肺动脉反流程度(分级：阴性/轻微、轻度/轻中度、中度和重度)。结果 共纳入515例患儿，平均随访2.3年。5年生存率达97.3%；死亡率1.7% (9/515)，死亡原因均与管道功能无关。总体再干预率6.6%(34/515，28例管道置换+6例内科介入)，使用ePTFE带瓣管道的患儿5年免于再手术率95.6%，使用BJV管道的患儿5年免于再手术率54.2%。随访心脏超声数据提示：大管道(≥22mm)免于再手术率最低，中位再手术时间达2.8年(小管道1.5年)，且5年免于肺动脉梗阻率最高(84.5%)。结论 带瓣管道在RVOT重建中展现出优秀的中期效果，BJV管道的应用会增加再手术风险，大尺寸管道可获得更持久的管道瓣膜功能。
- 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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备注/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