Current status of right ventricular outflow tract reconstruction: complete translation of a review article originally published in Kyobu Geka 2014;67:65-77.
Current status of right ventricular outflow tract reconstruction: complete translation of a review article originally published in Kyobu Geka 2014;67:65-77.
复制标题
右心室流出道重建的现状：最初发表于 Kyobu Geka 2014;67:65-77 的一篇评论文章的完整翻译。
DOI：
10.1007/s11748-014-0500-0
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发表时间：
2015
期刊：
影响因子：
--
通讯作者：
Yamamoto Y
中科院分区：
文献类型：
--
作者：
Yamamoto Y
右心室流出道（RVOT）重建正变得越来越普遍，因为成年患者在儿童期先天性心脏缺陷最终修复后很长时间内需要重复手术的人数增加。从手术干预的时机和适应症来看，早期初级修复和保留环手术是目前RVOT重建的两种策略；然而，这两种手术的长期结果仍然未知。尽管在RVOT重建过程中使用了各种各样的材料进行肺瓣膜置换术，但由于免疫排斥反应导致的耐久性不足经常出现，特别是当植入年轻患者时。日本的一项多中心研究表明，我们开发和制造的膨胀聚四氟乙烯（ePTFE）补片/导管的临床结果是RVOT重建的一种极好的替代材料。这种增强的结果可能部分归因于ePTFE的生物相容性和低抗原性，也归因于肿胀窦和扇形瓣膜的结构特征所引起的流体动力学特性。然而，关于RVOT重建的许多问题，如最终修复的适应症和时间，以及肺瓣膜置换术材料的选择，必须得到解决，以实现更好的患者预后和生活质量。这篇综述描述了最近的手术策略和与RVOT重建相关的突出问题。
Right ventricular outflow tract (RVOT) reconstruction is becoming more prevalent as the number of adult patients who require repeated surgery long after definitive repair of congenital heart defects during childhood has increased. Early primary repair and annulus-preserving surgery have been the two current strategies of RVOT reconstruction from the viewpoint of timing and indications for surgical intervention; however, the long-term outcomes of both procedures remain unknown. Although various materials have been used for pulmonary valve replacement during RVOT reconstruction, deficient durability due primarily to immunological rejection frequently arises, particularly when implanted into young patients. A multicenter study in Japan showed that the clinical outcomes of expanded polytetrafluoroethylene (ePTFE) valved patches/conduits that we developed and manufactured comprised an excellent alternative material for RVOT reconstruction. Such enhanced outcomes might have partly been attributable to the biocompatibility and low antigenicity of ePTFE, and also to the fluid dynamic properties arising from the structural characteristics of a bulging sinus and a fan-shaped valve. However, numerous issues concerning RVOT reconstruction, such as indications for and the timing of definitive repair, as well as the choice of materials for pulmonary valve replacement, must be resolved to achieve better patient prognoses and quality of life. This review describes recent surgical strategies and outstanding issues associated with RVOT reconstruction.