Smaller-Sized Expanded Polytetrafluoroethylene Conduits With a Fan-Shaped Valve and Bulging Sinuses for Right Ventricular Outflow Tract Reconstruction
Smaller-Sized Expanded Polytetrafluoroethylene Conduits With a Fan-Shaped Valve and Bulging Sinuses for Right Ventricular Outflow Tract Reconstruction
复制标题
DOI：
10.1016/j.athoracsur.2016.03.027
复制
发表时间：
2016-10-01
影响因子：
4.6
通讯作者：
Yaku, Hitoshi
中科院分区：
文献类型：
--
作者：
Yamashita, Eijiro;Yamagishi, Masaaki;Yaku, Hitoshi
背景。在用同种移植物和异种移植物重建右心室流出道（RVOT）时，限制导管寿命的关键因素之一是导管尺寸小。我们研究的目的是评估使用带有扇形瓣膜和凸出鼻窦的较小尺寸膨体聚四氟乙烯 (ePTFE) 导管进行 RVOT 重建的结果。方法。这项回顾性研究调查了 2003 年至 2014 年间在 63 家日本医院接受使用 ePTFE 导管进行 RVOT 重建的 303 名患者。纳入标准是导管尺寸小于或等于 16 毫米，并且使用手术治疗作为潜在心脏病的主要纠正措施。接受姑息治疗的患者被排除在外。结果。中位随访时间为 1.7 年。无需更换导管和无需重新干预导管的比例分别为 90.1% +/- 4.8% 和 77.2% +/- 5.6%。导管再干预的最常见适应症是肺动脉 (PA) 分叉狭窄 (82%)。将 z 分数建模为二分变量表明，与 z 分数小于 1.4 相比，z 分数大于或等于 1.4 的导管因 PA 分叉狭窄而无需进行导管再干预的自由度显着降低 (p=0.036)。有 30 名患者 (9.9%) 经历至少中度导管狭窄，21 名患者 (6.9%) 经历至少中度导管不全。单变量 Cox 回归分析表明导管尺寸是导管狭窄的一个重要因素 (p=0.006)。结论。即使使用较小尺寸，ePTFE 阀门导管也取得了优异的中期成果。 1.4 左右的导管 z 分数最适合年轻患者的 RVOT 重建。 (C) 2016 年胸外科医师协会
Background. One of the critical factors limiting conduit longevity in right ventricular outflow tract (RVOT) reconstruction with homografts and xenografts is the small size of the conduit. The aim of our study was to assess the outcome of using smaller-sized expanded polytetrafluoroethylene (ePTFE) conduits with a fan-shaped valve and bulging sinuses for RVOT reconstruction.Methods. This retrospective review examined 303 patients who underwent RVOT reconstruction with ePTFE conduits at 63 Japanese hospitals between 2003 and 2014. Inclusion criteria were a conduit size less than or equal to 16 mm and the use of operative treatment as the primary correction for underlying heart disease. Patients undergoing palliative procedures were excluded.Results. Median follow-up was 1.7 years. Freedom from conduit replacement and freedom from conduit reintervention were 90.1% +/- 4.8% and 77.2% +/- 5.6%, respectively. The most common indication for conduit reintervention was pulmonary artery (PA) bifurcation stenosis (82%). Modeling z-scores as a dichotomous variable revealed that freedom from conduit reintervention for PA bifurcation stenosis was significantly decreased for conduits with a z-score greater than or equal to 1.4 compared with z-scores less than 1.4 (p=0.036). There were 30 patients (9.9%) who experienced at least moderate conduit stenosis and 21 patients (6.9%) with at least moderate conduit insufficiency. Univariate Cox regression analysis showed that conduit size was a significant factor for conduit stenosis (p=0.006).Conclusions. Excellent midterm outcomes were achieved with ePTFE valved conduits, even when using smaller sizes. Conduit z-scores around 1.4 were optimal for RVOT reconstruction in younger patients. (C) 2016 by The Society of Thoracic Surgeons