Aortic arch reconstruction in newborns with an autologous pericardial patch: contemporary results
Aortic arch reconstruction in newborns with an autologous pericardial patch: contemporary results
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DOI：
10.1093/icvts/ivs510
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发表时间：
2013-03-01
影响因子：
--
通讯作者：
Murzi, Bruno
中科院分区：
文献类型：
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作者：
Bernabei, Massimo;Margaryan, Rafik;Murzi, Bruno
新生儿诺伍德手术和其他类型的主动脉弓重建术后复发性主动脉弓阻塞的发生率仍然很高。生物和合成材料用于扩大主动脉。回顾性分析了39例采用自体心包行主动脉弓重建术的患者的临床资料，其中39例患者分别行诺伍德型和其他类型的主动脉弓重建术。记录了复发性牙弓阻塞（平均压差>= 20 mmHg）及其处理。患者平均体重为3.2 ± 0.7 kg，初次手术矫正时的平均年龄为7.4 ± 6.8（范围1-35天）。所有患者出院时主动脉弓处均无明显残余压差，4例患者除外，其峰值压差>= 30 mmHg。复发性牙弓阻塞的总发生率为28.2%（11例患者）。4例（12.1%）患者发生远端梗阻，1例（3%）发生近端梗阻，1例发生中横弓梗阻。所有患者均行主动脉弓再介入球囊扩张术，3例扩张失败后行外科补片修补术，自体心包在主动脉弓重建术中的应用是有效的，并且与可接受的复发性弓阻塞发生率相关。其可用性和特性使其成为其他材料的有吸引力的替代品。
The incidence of recurrent aortic arch obstruction after Norwood procedure and other types of aortic arch reconstruction in newborns remains high. Biological and synthetic materials are used to enlarge the aorta. We report our experience using autologous pericardium to reconstruct the aortic arch in patients with hypoplastic left heart syndrome, aortic arch interruption and hypoplastic aortic arch.A retrospective analysis of 39 consecutively operated patients evaluated after an initial Norwood and other types aortic arch repair was performed. The presence of recurrent arch obstruction (mean gradient >= 20 mmHg) and its management were noted. The mean weight of our patients was 3.2 +/- 0.7 kg.The mean age at primary surgical correction was 7.4 +/- 6.8 (range 1-35 days). All patients were discharged without a significant residual gradient at the aortic arch except 4 who had a peak gradient of >= 30 mmHg. The overall incidence of recurrent arch obstruction was 28.2% (11 patients). Four (12.1%) patients had a distal obstruction, 1 (3%) had proximal obstruction and 1 had a mid-transverse arch obstruction. All patients underwent aortic arch reintervention consisting of balloon dilatation, and only after unsuccessful dilatation, 3 underwent surgical patch aortoplasties.The use of autologous pericardium in aortic arch reconstruction procedure is effective and associated with an acceptable incidence of recurrent arch obstruction. Its availability and characteristics make it an attractive alternative to other materials.