Right ventricular outflow tract reconstruction with the bovine jugular vein graft: 5 years' experience with 133 patients.
Right ventricular outflow tract reconstruction with the bovine jugular vein graft: 5 years' experience with 133 patients.
复制标题
用牛颈静脉移植物重建右心室流出道：5 年 133 名患者的经验。
DOI：
10.1016/j.athoracsur.2007.04.026
复制
发表时间：
2007
影响因子：
4.6
通讯作者：
M. Hazekamp
中科院分区：
文献类型：
--
作者：
N. Sekarski;H. van Meir;M. Rijlaarsdam;P. Schoof;D. Koolbergen;J. Hruda;L. V. von Segesser;E. Meijboom;M. Hazekamp
方法1999年4月至2005年7月，对133例儿童（年龄4天~ 19岁，中位年龄30.9个月）进行了牛颈静脉移植术。随访期间进行超声心动图检查并进行回顾性分析。8例患者发生了与TSN移植物相关的早期死亡。11例患者发生晚期死亡，2例与移植物相关（心内膜炎）。中位随访时间为31.6个月（范围：1 - 73）。12例患者接受了新的移植物，原因包括心内膜炎（3例）、远端肺动脉分支狭窄（4例）、纤维化引起的移植物阻塞（4例）或血栓形成（1例）。超声心动图多普勒研究显示管道功能良好，末次随访时92%的患者无、轻微或仅轻度瓣膜返流。在2名患者中观察到由于外部压缩导致的中度管道狭窄。25例导管完整的患者存在血流动力学显著的远端狭窄。肺分支狭窄多与术前肺动脉小、手术年龄小有关。在31.6个月时，在4个移植物中观察到显著的移植物扩张，并且与肺动脉分支阻塞或肺动脉高压相关。5年内未发生钙化。存活率为85.7%，自由从管道闭塞为91%，自由从肺动脉分支狭窄的干预是80%5 years. CONCLUSIONSSThe牛颈静脉移植是一个有价值的右心室流出道管道，但年轻的年龄和小肺动脉增加远端管道狭窄的风险。
BACKGROUNDWe analyzed the results in two centers of using bovine jugular vein graft for right ventricular outflow tract reconstruction.METHODSFrom April 1999 to July 2005, 133 children with a median age of 30.9 months (range, 4 days to 19 years) underwent graft implantation. Echocardiography was performed during follow-up and retrospectively reviewed.RESULTSNongraft-related early mortality occurred in 8 patients. Late mortality occurred in 11 patients, 2 late deaths were graft related (endocarditis). Median follow-up was 31.6 months (range, 1 to 73). Twelve patients received a new graft, because of endocarditis (3), distal pulmonary artery branch stenosis (4), graft obstruction caused by fibrosis (4), or thrombosis (1). Echocardiography Doppler studies showed good conduit function, with 92% of the patients having absent, trivial, or only mild valve regurgitation at last follow-up. A moderate degree of conduit stenosis due to external compression was observed in 2 patients. Twenty-five patients with otherwise intact conduits had hemodynamically significant distal stenosis. In most cases, the pulmonary branch stenosis was related to preoperative small pulmonary arteries and young age at operation. At 31.6 months, significant graft dilatation was observed in 4 grafts and was related to pulmonary artery branch obstruction or pulmonary hypertension. Calcification did not occur in 5 years time. Survival was 85.7%, freedom from conduit explantation was 91%, and freedom from intervention for pulmonary artery branch stenosis was 80% after 5 years.CONCLUSIONSThe bovine jugular vein graft is a valuable right ventricular outflow tract conduit, but younger age and small pulmonary arteries increase the risk of distal conduit stenosis.