Reoperation in adults with repair of tetralogy of Fallot: Indications and outcomes
Reoperation in adults with repair of tetralogy of Fallot: Indications and outcomes
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DOI：
10.1016/s0022-5223(99)70214-x
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发表时间：
1999-08-01
影响因子：
6
通讯作者：
Williams, WG
中科院分区：
文献类型：
--
作者：
Oechslin, EN;Harrison, DA;Williams, WG
目的：本研究的目的是回顾成人法洛四联症修复后再手术的适应症、手术方法和结果。方法：回顾了1975年至1997年间60例法洛四联症修复后再次手术的连续成人（年龄大于或等于18岁）。矫正修复的平均年龄为13.3 +/- 9.6岁，再手术的平均年龄为33.3 +/- 9.6岁。再手术后平均随访5.0±4.9年。结果：右室流出道长期并发症（n = 45, 75%）是再手术最常见的适应症，严重肺返流（n = 23, 38%）和导管衰竭（n = 13, 22%）是再手术最常见的适应症。较不常见的适应症是室间隔补片泄漏（n = 6）和严重三尖瓣反流（n = 3）。20例（33%）患者存在持续性室性心动过速史，9例（15%）患者发生室上性心动过速。42例患者使用生物瓣膜重建右心室流出道，46例患者（77%）需要额外的手术（n = 115）来纠正其他残留病变。无围手术期死亡。精算10年生存率为92%±6%。在最近的随访中，93%的患者属于纽约心脏协会的I级或II级。随访期间，4例（7%）患者出现持续性室性心动过速。结论：右室流出道长期并发症是再次手术的主要原因。术后中期生存率及功能改善均良好。
Objective: The purpose of this study is to review indications, surgical procedures, and outcomes in adults with repaired tetralogy of Fallot referred for reoperation. Method: Sixty consecutive adults (age greater than or equal to 18 years) who underwent reoperation between 1975 and 1997 after previous repair of tetralogy of Fallot were reviewed. Mean age at corrective repair was 13.3 +/- 9.6 years and at reoperation 33.3 +/- 9.6 years. Mean follow-up after reoperation is 5.0 +/- 4.9 years. Results: Long-term complications of the right ventricular outflow tract (n = 45, 75%) were the most common indications for reoperation: severe pulmonary regurgitation (n = 23, 38%) and conduit failure (n = 13, 22%) were most frequent. Less common indications were ventricular septal patch leak (n = 6) and severe tricuspid regurgitation (n = 3). A history of sustained ventricular tachycardia was present in 20 patients (33%) and supraventricular tachycardia occurred in 9 patients (15%). A bioprosthetic valve to reconstruct the right ventricular outflow tract was used in 42 patients, Additional procedures (n = 115) to correct other residual lesions were required in 46 patients (77%). There was no perioperative mortality. Actuarial 10-year survival is 92% +/- 6%. At most recent follow-up, 93% of the patients are in New York Heart Association classification I or II. Sustained ventricular tachycardia occurred in 4 patients (7%) during follow-up. Conclusions: Long-term complications of the right ventricular outflow tract were the main reason for reoperation. Mid-term survival and functional improvement after reoperation are excellent.