中国胸心血管外科临床杂志

中国胸心血管外科临床杂志

人工肺动脉瓣重建技术在右室流出道重建中的应用

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目的 评估一种人工肺动脉瓣重建技术在右心室流出道重建手术中的可行性及可靠性。 方法 回顾性分析我中心自 2012 年 2 月至 2016 年 12 月之间右室流出道重建手术 35 例患儿术中使用人工肺动脉瓣重建技术的情况,并随访其近中期临床结局。男 19 例、女 16 例,平均接受手术年龄 10 岁(5 个月至 42 岁),体重 26(8~62)kg。人工肺动脉瓣重建技术类型包括:人工单瓣技术 21 例,人工双瓣技术 6 例,综合成形法 8 例。 结果 平均体外循环时间 75~251(120±37)min,主动脉阻断时间 32~185(72±28)min,术后呼吸机辅助时间 6~68(24±18)h,重症监护室停留时间 14~225(59±51)h,术后早期死亡 3 例均与人工肺瓣重建技术无明显相关性。平均随访时间 15 个月。术前瓣膜反流情况:无反流 22 例,轻度 1 例、中度 7 例、重度 3 例。术后随访终点瓣膜反流情况:无瓣膜反流 8 例,轻度反流 22 例,中度反流 5 例,无重度反流患者。术后肺动脉瓣相关狭窄 2 例,均为轻度狭窄。无瓣膜相关再次手术,延迟关胸 3 例。术后早期死亡 3 例,未随访到远期死亡患者。存活 32 例患者,纽约心功能评级 Ⅰ 级 20 例,Ⅱ 级 10 例,Ⅲ 级 2 例。 结论 在右室流出道重建手术中运用人工肺动脉瓣重建技术,可以减轻术后早期右心室容量负荷,使患者平稳度过围术期,其外科技术简便易施行,费用低廉,近中期安全性较好,但远期仍需进一步观察随访。

Objective To evaluate the technique of artificial pulmonary valve reconstruction in right ventricular outflow tract reconstruction of possibility and reliability. Methods We retrospectively analyzed the clinical data of 35 patients with artificial pulmonary valve reconstruction of right ventricular outflow tract reconstruction surgery in our hospital between February 2012 and December 2016. There were 35 patients with 19 males and 16 females at age of 10 years ranged 5 months to 42 years and body weight of 26 (8–62) kg. There were 21 patients with artificial single example, 6 patients with artificial disc technology, 8 patients with comprehensive forming method. Results Average extracorporeal circulation time was 75–251 (120±37) min. Aorta blocking time minutes was 32–185 (72±28) min. ICU stay time was 14–225 (59±51) hours. Breathing machine auxiliary time was 6–68 (24±18) hours. There were 3 early postoperative death. There was no death during the long term following-up time. Thirty-two patients survived with heart function of class Ⅰ in 20 patients, class Ⅱ in 10 patients, class Ⅲ in 2 patients. Conclusion In right ventricular outflow tract reconstruction using the technique of artificial pulmonary valve reconstruction in the operation, can reduce early postoperative right ventricular volume load increased significantly, to smooth out perioperative patients, the surgical technique is simple easy, cheap, recent security is good, but long-term follow-up still need further observation.

关键词: 人工肺动脉瓣; 右室流出道重建; 肺动脉瓣反流

Key words: Artificial pulmonary valve reconstruction technology; right ventricular outflow tract reconstruction; pulmonary valve regurgitation

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1. Göber V, Berdat P, Pavlovic M, et al. Adverse mid-term outcome following RVOT reconstruction using the Contegra valved bovine jugular vein. Ann Thorac Surg, 2005, 79(2): 625-631.
2. He GW. A new technique of transannular monocusp patch-repair of the right ventricular outflow tract in repair of Tetralogy of Fallot. Heart Lung Circ, 2007, 16(2): 107-112.
3. Reyes KG, Cuaso CC, Tan RB. Double-barrel right ventricular outflow: tetralogy of Fallot annulus preservation technique. Ann Thorac Surg, 2012, 94(3): 1023-1025.
4. Kalfa D, Bel A, Chen-Tournoux A, et al. A polydioxanone electrospun valved patch to replace the right ventricular outflow tract in a growing lamb model. Biomaterials, 2010, 31(14): 4056-4063.
5. Quintessenza JA, Jacobs JP, Morell VO, et al. Initial experience with a bicuspid polytetrafluoroethylene pulmonary valve in 41 children and adults: a new option for right ventricular outflow tract reconstruction. Ann Thorac Surg, 2005, 79(3): 924-931.
6. Lee C, Kim YM, Lee CH, et al. Outcomes of pulmonary valve replacement in 170 patients with chronic pulmonary regurgitation after relief of right ventricular outflow tract obstruction: implications for optimal timing of pulmonary valve replacement. J Am Coll Cardiol, 2012, 60(11): 1005-1014.
7. Turrentine MW, McCarthy RP, Vijay P, et al. PTFE monocusp valve reconstruction of the right ventricular outflow tract. Ann Thorac Surg, 2002, 73(3): 871-879.
8. Turrentine MW, McCarthy RP, Vijay P, et al. Polytetrafluoroethylene monocusp valve technique for right ventricular outflow tract reconstruction. Ann Thorac Surg, 2002, 74(6): 2202-2205.
9. Luo QZ, Lin L, Gong Z, et al. Positive association of major histocompatibility complex class I chain-related gene A polymorphism with leukemia susceptibility in the people of Han nationality of Southern China. Tissue Antigens, 2011, 78(3): 178-184.
10. Nath DS, Nussbaum DP, Yurko C, et al. Pulmonary homograft monocusp reconstruction of the right ventricular outflow tract: outcomes to the intermediate term. Ann Thorac Surg, 2010, 90(1): 42-49.
11. Ootaki Y, Welch AS, Walsh MJ, et al. Medium-term outcomes after implantation of expanded polytetrafluoroethylene valved conduit. Ann Thorac Surg, 2018, 105(3): 843-850.
12. Lee C, Lee CH, Kwak JG, et al. Bicuspid pulmonary valve implantation using polytetrafluoroethylene membrane: early results and assessment of the valve function by magnetic resonance imaging. Eur J Cardiothorac Surg, 2013, 43(3): 468-472.
13. Lee C, Lee CH, Kwak JG. Polytetrafluoroethylene Bicuspid Pulmonary Valve Replacement: A 5-Year Experience in 119 Patients With Congenital Heart Disease. Ann Thorac Surg, 2016, 102(1): 163-169.
14. Kumar M, Turrentine MW, Rodefeld MD, et al. Right Ventricular Outflow Tract Reconstruction With a Polytetrafluoroethylene Monocusp Valve: A 20-Year Experience. Semin Thorac Cardiovasc Surg, 2016, 28(2): 463-470.
15. Bacha E. Valve-Sparing or Valve Reconstruction Options in Tetralogy of Fallot Surgery. Semin Thorac Cardiovasc Surg Pediatr Card Surg Annu, 2017, 20: 79-83.
16. Brown JW, Ruzmetov M, Rodefeld MD, et al. Valved bovine jugular vein conduits for right ventricular outflow tract reconstruction in children: an attractive alternative to pulmonary homograft. Ann Thorac Surg, 2006, 82(3): 909-916.
17. Ando M, Takahashi Y. Ten-year experience with handmade trileaflet polytetrafluoroethylene valved conduit used for pulmonary reconstruction. J Thorac Cardiovasc Surg, 2009, 137(1): 124-131.
18. Belli E, Salihoğlu E, Leobon B, et al. The performance of Hancock porcine-valved Dacron conduit for right ventricular outflow tract reconstruction. Ann Thorac Surg, 2010, 89(1): 152-157.
19. Gil-Jaurena JM, Ferreiros M, Castillo R, et al. Use of a pulmonary neovalve with a transannular patch for repair of tetralogy of fallot. Rev Esp Cardiol, 2010, 63(12): 1438-1443.
20. Salem AM. Right ventricle to pulmonary artery connection: Evolution and current alternatives. J Egypt Soc Cardio-Thorac Surg, 2016, 24(1): 47-57.
21. Brown JW, Ruzmetov M, Vijay P, et al. Right ventricular outflow tract reconstruction with a polytetrafluoroethylene monocusp valve: a twelve-year experience. J Thorac Cardiovasc Surg, 2007, 133(5): 1336-1343.
22. Papadopoulos N, Esmaeili A, Zierer A, et al. Secondary repair of incompetent pulmonary valves. Ann Thorac Surg, 2009, 87(6): 1879-1884.
23. Bove T, François K, De Wolf D. New Insights into the Surgical Management of Tetralogy of Fallot: Physiological Fundamentals and Clinical Relevance. Curr Pediatr Rev, 2015, 11(2): 72-86.
24. Geva T, Gauvreau K, Powell AJ, et al. Randomized trial of pulmonary valve replacement with and without right ventricular remodeling surgery, Circulation, 2010, 122: 5201-5208.
25. Tweddell JS, Simpson P, Li SH, et al. Timing and technique of pulmonary valve replacement in the patient with tetralogy of Fallot. Semin Thorac Cardiovasc Surg Pediatr Card Surg Annu, 2012, 15(1): 27-33.
26. Hallbergson A, Gauvreau K, Powell AJ, et al. Right ventricular remodeling after pulmonary valve replacement: early gains, late losses. Ann Thorac Surg, 2015, 99(2): 660-666.
27. Valente AM, Gauvreau K, Assenza GE, et al. Contemporary predictors of death and sustained ventricular tachycardia in patients with repaired tetralogy of Fallot enrolled in the INDICATOR cohort, Heart, 2014, 100(3): 247-253.
28. Cheatham JP, Hellenbrand WE, Zahn EM, et al. Clinical and hemodynamic outcomes up to 7 years after transcatheter pulmonary valve replacement in the US Melody Valve Investigational Device Exemption Trial. Circulation, 2015, 131(22): 1960-1970.
29. Kogon BE, Rosenblum JM, Mori M. Current readings: issues surrounding pulmonary valve replacement in pediatric cardiac disease: a scientific statement from the American Heart Association, Circulation, 2011, 123: 2607-2652.