Repair of Untreated Older Patients With Tetralogy of Fallot With Major Aortopulmonary Collaterals
Repair of Untreated Older Patients With Tetralogy of Fallot With Major Aortopulmonary Collaterals
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DOI：
10.1016/j.athoracsur.2018.11.016
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发表时间：
2019-04-01
影响因子：
4.6
通讯作者：
McElhinney, Doff B.
中科院分区：
文献类型：
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作者：
Vaikunth, Sumeet S.;Bauser-Heaton, Holly;McElhinney, Doff B.
背景我们对法洛四联症合并严重的先天性心脏病侧支循环的程序化治疗强调在婴儿期进行一期单灶性完全心内修复。对于婴儿期以后的患者是否适合完全修复知之甚少。我们试图分析我们的方法在既往未经治疗的法洛四联症伴主支气管分支的老年患者中的结果。2002年至2017年期间，任何在2岁之前未接受治疗的该病变患者均符合入选标准。在33例患者中，32例为州外（64%为国际）转诊，33%（n = 11）年龄大于9岁，患有红细胞增多症或至少有1个高压侧支循环（>25 mm Hg）。在94%（n = 31）的患者中实现了完全修复，82%（n = 27）在一期手术中实现，12%（n = 4）在中央分流管单向定位后实现。术后右心室-主动脉压比中位数为0.31，随访时为0.37。在修复后中位4.8年，9例患者（19%）接受了再次介入，包括5例管道和7例分支肺动脉介入。3例患者还接受了主动脉瓣置换术。在这个选择的队列中，既往未手术的法洛四联症伴主要的肺动脉分支的老年患者，其结局与根据我们的方法接受治疗的婴儿相当。这些发现支持了这样一种观点，即出生在低资源环境中或婴儿期后接受医疗保健提供者治疗的患者应被视为候选人并进行完全修复评估。(C)2019年美国胸外科医师协会
Background. Our programmatic approach to tetralogy of Fallot with major aortopulmonary collaterals emphasizes single-stage unifocalization with complete intra-cardiac repair during infancy. Little is known about suitability for complete repair in patients beyond infancy. We sought to analyze outcomes of our approach in older patients with previously untreated tetralogy of Fallot with major aortopulmonary collaterals.Methods. Any patient with this lesion not treated before 2 years of age referred to our center from 2002 to 2017 met inclusion criteria.Results. Of 33 patients, 32 were out-of-state (64% international) referrals, and 33% (n = 11) were older than 9 years, had polycythemia, or at least 1 high pressure collateral (>25 mm Hg). Complete repair was achieved in 94% (n = 31) of patients, 82% (n = 27) in one stage and 12% (n = 4) after unifocalization to a central shunt. The median right ventricular-to-aortic pressure ratio was 0.31 after the operation and 0.37 at follow-up. At a median of 4.8 years after repair, 9 patients (19%) underwent reintervention, including 5 conduit and 7 branch pulmonary artery interventions. Three patients also underwent aortic valve replacement.Conclusions. In this selected cohort of older patients with previously unoperated tetralogy of Fallot with major aortopulmonary collaterals, outcomes were comparable with infants undergoing treatment according to our approach. These findings support the notion that patients who are either born in low-resource settings or present to health care providers beyond infancy should be considered candidates and evaluated for complete repair. (C) 2019 by The Society of Thoracic Surgeons