Jugular venous valved conduit (Contegra®) matches allograft performance in infant truncus arteriosus repair
Jugular venous valved conduit (Contegra®) matches allograft performance in infant truncus arteriosus repair
复制标题
DOI：
10.1016/j.ejcts.2007.12.052
复制
发表时间：
2008-05-01
影响因子：
3.4
通讯作者：
Hawkins, John
中科院分区：
文献类型：
--
作者：
Hickey, Edward J.;McCrindle, Brian W.;Hawkins, John
目的：同种异体移植管道的可用性和耐久性有限，需要考虑替代品。我们比较了107例存活于动脉干修复术的婴儿的牛颈静脉带瓣（JVV）和同种异体移植管道的性能。方法：2003年至2007年，从17个机构前瞻性招募儿童。JVV（n = 27，均为12 mm）的中位z评分为+2.1（范围+1.2至+3.2），同种异体移植物（n = 80，9 - 15 mm）为+1.7（范围-0.4至+3.6）。使用参数风险-危害分析和竞争风险技术进行了管道存活率的倾向调整比较。所有可用的超声心动图（n = 745）被用来模拟回归方程中的管道功能的恶化调整重复测量。结果：3年时总管道存活率为64 +/-9%。导管置换术用于导管狭窄（n = 16）和/或肺动脉狭窄（n = 18）或返流（n = 1）。JVV和同种异体移植物的3年无导管内狭窄置换率分别为96 +/-4%和69 +/-8%（p = 0.05）。对于JVV和同种异体移植物，分支肺动脉狭窄的介入或置换风险相似。导管z分数越小，预测的导管性能越差（p <0.01），最佳结果在+1和+3之间。尽管JVV导管直径均匀，但其z分数更一致地匹配该理想。JVV表现出导管返流和右心室流出道（RVOT）峰值压差进展缓慢的非显著趋势。此外，导管介入在抑制JVV患儿随后的梯度进展方面比同种异体移植更成功（p <0.01）。结论：JVV确实与同种异体移植物性能相匹配，可能是有利的。它是动脉干修复的合适首选，也可能是其他需要RVOT重建的小婴儿。(C)2008年欧洲胸外科协会。Elsevier B.V.出版，保留所有权利。
Objective: Limited availability and durability of allograft conduits require that alternatives be considered. We compared bovine jugular venous valved (JVV) and allograft conduit performance in 107 infants who survived truncus arteriosus repair. Methods: Children were prospectively recruited between 2003 and 2007 from 17 institutions. The median z-score for JVV (n = 27, all 12 mm) was +2.1 (range +1.2 to +3.2) and allograft (n = 80, 9-15 mm) was +1.7 (range -0.4 to +3.6). Propensity-adjusted comparison of conduit survival was undertaken using parametric risk-hazard analysis and competing risks techniques. All available echocardiograms (n = 745) were used to model deterioration of conduit function in regression equations adjusted for repeated measures. Results: Overall conduit survival was 64 +/- 9% at 3 years. Conduit replacement was for conduit stenosis (n = 16) and/or pulmonary artery stenosis (n = 18) or regurgitation (n = 1). The propensity-adjusted 3-year freedom from replacement for in-conduit stenosis was 96 +/- 4% for JVV and 69 +/- 8% for allograft (p = 0.05). The risk of intervention or replacement for branch pulmonary artery stenosis was similar for JVV and allograft. Smaller conduit z-score predicted poor conduit performance (p < 0.01) with best outcome between +1 and +3. Although JVV conduits were a uniform diameter, their z-score more consistently matched this ideal. JVV exhibited a non-significant trend towards slower progression of conduit regurgitation and peak right ventricular outflow tract (RVOT) gradient. In addition, catheter intervention was more successful at stowing subsequent gradient progression in children with JVV versus those with allograft (p < 0.01). Conclusions: JVV does match allograft performance and may be advantageous. It is an appropriate first choice for repair of truncus arteriosus, and perhaps other small infants requiring RVOT reconstruction. (C) 2008 European Association for Cardio-Thoracic Surgery. Published by Elsevier B.V. All rights reserved.