Transannular patching is a valid alternative for tetralogy of Fallot and complete atrioventricular septal defect repair.
Transannular patching is a valid alternative for tetralogy of Fallot and complete atrioventricular septal defect repair.
复制标题
经瓣膜修补是法洛四联症和房室间隔缺损完全修复的有效替代方案。
DOI：
10.1016/j.jtcvs.2008.09.055
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发表时间：
2009
期刊：
影响因子：
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通讯作者：
R. D. Di Donato
中科院分区：
文献类型：
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作者：
G. Brancaccio;G. Michielon;S. Filippelli;G. Perri;D. Di Carlo;F. Iorio;G. Oricchio;R. Iacobelli;A. Amodeo;R. D. Di Donato
目的：我们报告法洛四联症合并完全性房室间隔缺损的修复经验，特别是在右心室流出道置放肺动脉瓣的需要。方法1992 ~ 2006年收治法洛四联症合并完全性房室间隔缺损患儿33例；26人患有唐氏综合症（79%）。32例患儿完全修复（初级18例，分期14例）；在最初接受姑息治疗的15人中，1人在完全修复前死亡。右心室流出道阻塞14例（42%），保留肺动脉瓣的小脑补片7例（21%），右心室-肺动脉导管11例（33%）。结果无院内死亡病例。精算生存率为5年96%±3.9%，10年85.9±1.1%。多因素分析显示，缓解右心室流出道阻塞的类型不影响生存（P = 0.16），选择使用有瓣导管也不影响生存（P = 0.82）。初次矫正（P = 0.05）和修复时较轻的体重（P = 0.05）与较高的生存概率相关。平均随访69.3±5.9个月（0.2 ~ 282个月）。有2人晚死。5年和10年的再手术成功率分别为69%和38%。不使用带瓣导管的右心室流出道重建可显著提高再次介入的自由度（P < 0.05）。结论法洛特四联症合并完全性房室间隔缺损可以低风险矫正，中期生存期良好。三分之二的患者可以避免使用右心室至肺动脉导管，对生存没有影响，可能提高再次干预的总体自由度。
OBJECTIVEWe report our experience with repair of tetralogy of Fallot associated with complete atrioventricular septal defect, addressing in particular the need for a pulmonary valve in the right ventricular outflow tract.METHODSBetween 1992 and 2006, 33 children with tetralogy of Fallot and complete atrioventricular septal defect were admitted; 26 had Down's syndrome (79%). Thirty-two children had complete repair (18 primary, 14 staged); of the 15 who received initial palliation, 1 died before complete repair. Right ventricular outflow tract obstruction was relieved by transannular patch in 14 cases (42%), infundibular patch with preservation of the pulmonary valve in 7 (21%), and right ventricle–to–pulmonary artery conduit in 11 (33%).RESULTSThere were no hospital deaths. Actuarial survival was 96% ± 3.9% at 5 years and 85.9 ± 1.1% at 10 years. Multivariate analysis showed that type of relief of right ventricular outflow tract obstruction did not influence survival (P = .16), nor did the choice to use a valved conduit (P = .82). Primary correction (P = .05) and lower weight at repair (P = .05) were associated with higher probability of survival. Mean follow-up was 69.3 ± 5.9 months (range 0.2–282 months). There were 2 late deaths. Overall freedom from reoperation was 69% at 5 years and 38% at 10 years. Right ventricular outflow tract reconstruction without use of a valved conduit allowed a significantly higher freedom from reinterventions (P < .05).CONCLUSIONSTetralogy of Fallot associated with complete atrioventricular septal defect can be corrected at low risk with favorable intermediate survival. Use of right ventricle–to–pulmonary artery conduit can be avoided in two thirds of patients with no impact on survival, possibly improving overall freedom from reintervention.