永存动脉干的外科治疗及早中期随访
|
摘要
目的探索永存动脉干患儿外科矫治的早中期结果。方法回顾性分析2009年11月至2018年5月27例在我科接受外科治疗的永存动脉干患儿的临床资料、外科手术方法、早期死亡率及中期随访结果。其中男14例、女13例。接受手术中位年龄3个月(13 d至11岁),>6个月者10例(37.0%)。中位体重5.4(3.2～21.2)kg。结果手术死亡3例(死亡率11.1%),30 d存活率88.9%。手术主要并发症包括室间隔开窗2例,Ⅲ°房室传导阻滞1例。存活患儿平均随访时间1～76(24.5±19.3)个月,随访期死亡3例,失访2例。随访发现:中度及以上肺动脉狭窄7例,包括肺动脉主干狭窄3例,左右肺动脉开口狭窄各2例;中度主动脉瓣反流1例。全组暂无再次干预病例。1年和5年生存率均为76.1%(95%CI 59.2%～92.9%)。结论永存动脉干的治疗仍面临挑战。早期一期根治手术风险较低,早中期效果满意;而患儿年龄偏大,合并重度肺动脉高压和/或共干瓣反流者,死亡风险较高。部分患儿仍存在较高的晚期右心室流出道或左/右肺动脉分支再梗阻风险,需要密切随访。
Objective To evaluate the early-and mid-term outcomes of surgical repair of persistent truncus arteriosus in children in a single institution of China. Methods The clinical data of 27 consecutive patients with persistent truncus arteriosus undergoing surgical repair in Guangzhou Women and Children's Medical Center from November 2009 to May 2018 were retrospectively reviewed. There were 14 males and 13 females. Median age was 3.0 months(range: 13 days-11 years), of whom 10(37.0%) were older than 6 months. Results There were three early deaths with a mortality of 11.1%. The main complications included VSD partial repair in 2 patients, complete atrioventricular block in one patient. The mean follow-up time was 24.5±19.3 months(range: 1–76 months). There were three late deaths, and two patients lost follow. Echocardiology showed seven patients of right heart outflow tract obstruction,including three in pulmonary artery trunk, and four of pulmonary artery branches. One patient showed moderate aortic valve regurgitation. None required re-intervention during the follow-up. Survival estimates for the entire cohort following surgery were both 76.1%(95%CI 59.2% to 92.9%) at 1 year and 5 years. Conclusion The surgical repair of persistent truncus arteriosus(PTA) remains challenges. The early-and mid-term outcomes of surgical repair of persistent truncus arteriosus are acceptable. For older children with severe pulmonary artery hypertension and/or trunk valve regurgitation, the risk of death is still higher. Some children have the higher risk of late right heart obstructive lesions.
Objective To evaluate the early-and mid-term outcomes of surgical repair of persistent truncus arteriosus in children in a single institution of China. Methods The clinical data of 27 consecutive patients with persistent truncus arteriosus undergoing surgical repair in Guangzhou Women and Children's Medical Center from November 2009 to May 2018 were retrospectively reviewed. There were 14 males and 13 females. Median age was 3.0 months(range: 13 days-11 years), of whom 10(37.0%) were older than 6 months. Results There were three early deaths with a mortality of 11.1%. The main complications included VSD partial repair in 2 patients, complete atrioventricular block in one patient. The mean follow-up time was 24.5±19.3 months(range: 1–76 months). There were three late deaths, and two patients lost follow. Echocardiology showed seven patients of right heart outflow tract obstruction,including three in pulmonary artery trunk, and four of pulmonary artery branches. One patient showed moderate aortic valve regurgitation. None required re-intervention during the follow-up. Survival estimates for the entire cohort following surgery were both 76.1%(95%CI 59.2% to 92.9%) at 1 year and 5 years. Conclusion The surgical repair of persistent truncus arteriosus(PTA) remains challenges. The early-and mid-term outcomes of surgical repair of persistent truncus arteriosus are acceptable. For older children with severe pulmonary artery hypertension and/or trunk valve regurgitation, the risk of death is still higher. Some children have the higher risk of late right heart obstructive lesions.
引文
1Brown JW, Ruzmetov M, Okada Y, et al. Truncus arteriosus repair:outcomes, risk factors, reoperation and management. Eur J Cardiothorac Surg, 2001, 20(2):221-227.
2邹明晖,马力,陈欣欣,等.扩大的端侧吻合一期修复主动脉弓中断诊治分析.中华外科杂志, 2018, 56(3):217-220.
3Naimo PS, Fricke TA, Yong MS, et al. Outcomes of truncus arteriosus repair in children:35 years of experience from a single institution. Semin Thorac Cardiovasc Surg, 2016, 28(2):500-511.
4Asagai S, Inai K, Shinohara T, et al. Long-term outcomes after truncus arteriosus repair:A single-center experience for more than 40 years. Congenit Heart Dis, 2016, 11(6):672-677.
5Xu ZW, Shen J. Repair of truncus arteriosus:choice of right ventricle outflow reconstruction. J Card Surg, 2010, 25(6):724-729.
6Zhang Y, Li SJ, Yan J, et al. Mid-term results after correction of typeⅠand typeⅡpersistent truncus arteriosus in older patients. J Card Surg, 2012, 27(2):228-230.
7Honjo O, Kotani Y, Akagi T, et al. Right ventricular outflow tract reconstruction in patients with persistent truncus arteriosus:a 15-year experience in a single Japanese center. Circ J, 2007, 71(11):1776-1780.
8Sinzobahamvya N, Boscheinen M, Blaschczok HC, et al. Survival and reintervention after neonatal repair of truncus arteriosus with valved conduit. Eur J Cardiothorac Surg, 2008, 34(4):732-737.
9Derby CD, Kolcz J, Gidding S, et al. Outcomes following nonvalved autologous reconstruction of the right ventricular outflow tract in neonates and infants. Eur J Cardiothorac Surg, 2008, 34(4):726-731.
10Danton MH, Barron DJ, Stumper O, et al. Repair of truncus arteriosus:a considered approach to right ventricular outflow tract reconstruction. Eur J Cardiothorac Surg, 2001, 20(1):95-104.
11Nemoto S, Ozawa H, Sasaki T, et al. Repair of persistent truncus arteriosus without a conduit:sleeve resection of the pulmonary trunk from the aorta and direct right ventricle-pulmonary artery anastomosis. Eur J Cardiothorac Surg, 2011, 40(3):563-568.
12Barbero-Marcial M, Riso A, Jatene A, et al. A technique for correction of truncus arteriosus typesⅠandⅡwithout extracardiac conduits. J Thorac Cardiovasc Surg, 1990, 99(2):364-369.
13Raisky O, Ben Ali W, Bajolle F, et al. Common arterial trunk repair:with conduit or without? Eur J Cardiothorac Surg, 2009,36(4):675-682.
14Hanley FL, Heinemann MK, Jonas RA, et al. Repair of truncus arteriosus in the neonate. J Thorac Cardiovasc Surg, 1993, 105(6):1047-1056.
15Rajasinghe HA, McElhinney DB, Reddy VM, et al. Long-term follow-up of truncus arteriosus repaired in infancy:a twenty-year experience. J Thorac Cardiovasc Surg, 1997, 113(5):869-879.
16Kaza AK, Burch PT, Pinto N, et al. Durability of truncal valve repair. Ann Thorac Surg, 2010, 90(4):1307-1312.
17Russell HM, Pasquali SK, Jacobs JP, et al. Outcomes of repair of common arterial trunk with truncal valve surgery:a review of the society of thoracic surgeon’s congenital heart surgery database.Ann Thorac Surg, 2012, 93(1):164-169.
18Mavroudis C, Backer CL. Surgical management of severe truncal insufficiency:experience with truncal valve remodeling techniques.Ann Thorac Surg, 2001, 72(2):396-400.
19仇黎生,孙彦隽,刘锦纷,等.小儿永存动脉干外科治疗54例分析.中华外科杂志, 2012, 50(9):827-830.
20张岩,李守军,闫军,等.Ⅰ型和Ⅱ型永存动脉干的外科治疗结果及随访分析.中国胸心血管外科临床杂志, 2012, 19(1):19-21.
21王潇,金晶,陶凉,等.错过最佳手术时机永存动脉干患者的外科治疗.中国胸心血管外科临床杂志, 2013, 20(3):269-272.
2邹明晖,马力,陈欣欣,等.扩大的端侧吻合一期修复主动脉弓中断诊治分析.中华外科杂志, 2018, 56(3):217-220.
3Naimo PS, Fricke TA, Yong MS, et al. Outcomes of truncus arteriosus repair in children:35 years of experience from a single institution. Semin Thorac Cardiovasc Surg, 2016, 28(2):500-511.
4Asagai S, Inai K, Shinohara T, et al. Long-term outcomes after truncus arteriosus repair:A single-center experience for more than 40 years. Congenit Heart Dis, 2016, 11(6):672-677.
5Xu ZW, Shen J. Repair of truncus arteriosus:choice of right ventricle outflow reconstruction. J Card Surg, 2010, 25(6):724-729.
6Zhang Y, Li SJ, Yan J, et al. Mid-term results after correction of typeⅠand typeⅡpersistent truncus arteriosus in older patients. J Card Surg, 2012, 27(2):228-230.
7Honjo O, Kotani Y, Akagi T, et al. Right ventricular outflow tract reconstruction in patients with persistent truncus arteriosus:a 15-year experience in a single Japanese center. Circ J, 2007, 71(11):1776-1780.
8Sinzobahamvya N, Boscheinen M, Blaschczok HC, et al. Survival and reintervention after neonatal repair of truncus arteriosus with valved conduit. Eur J Cardiothorac Surg, 2008, 34(4):732-737.
9Derby CD, Kolcz J, Gidding S, et al. Outcomes following nonvalved autologous reconstruction of the right ventricular outflow tract in neonates and infants. Eur J Cardiothorac Surg, 2008, 34(4):726-731.
10Danton MH, Barron DJ, Stumper O, et al. Repair of truncus arteriosus:a considered approach to right ventricular outflow tract reconstruction. Eur J Cardiothorac Surg, 2001, 20(1):95-104.
11Nemoto S, Ozawa H, Sasaki T, et al. Repair of persistent truncus arteriosus without a conduit:sleeve resection of the pulmonary trunk from the aorta and direct right ventricle-pulmonary artery anastomosis. Eur J Cardiothorac Surg, 2011, 40(3):563-568.
12Barbero-Marcial M, Riso A, Jatene A, et al. A technique for correction of truncus arteriosus typesⅠandⅡwithout extracardiac conduits. J Thorac Cardiovasc Surg, 1990, 99(2):364-369.
13Raisky O, Ben Ali W, Bajolle F, et al. Common arterial trunk repair:with conduit or without? Eur J Cardiothorac Surg, 2009,36(4):675-682.
14Hanley FL, Heinemann MK, Jonas RA, et al. Repair of truncus arteriosus in the neonate. J Thorac Cardiovasc Surg, 1993, 105(6):1047-1056.
15Rajasinghe HA, McElhinney DB, Reddy VM, et al. Long-term follow-up of truncus arteriosus repaired in infancy:a twenty-year experience. J Thorac Cardiovasc Surg, 1997, 113(5):869-879.
16Kaza AK, Burch PT, Pinto N, et al. Durability of truncal valve repair. Ann Thorac Surg, 2010, 90(4):1307-1312.
17Russell HM, Pasquali SK, Jacobs JP, et al. Outcomes of repair of common arterial trunk with truncal valve surgery:a review of the society of thoracic surgeon’s congenital heart surgery database.Ann Thorac Surg, 2012, 93(1):164-169.
18Mavroudis C, Backer CL. Surgical management of severe truncal insufficiency:experience with truncal valve remodeling techniques.Ann Thorac Surg, 2001, 72(2):396-400.
19仇黎生,孙彦隽,刘锦纷,等.小儿永存动脉干外科治疗54例分析.中华外科杂志, 2012, 50(9):827-830.
20张岩,李守军,闫军,等.Ⅰ型和Ⅱ型永存动脉干的外科治疗结果及随访分析.中国胸心血管外科临床杂志, 2012, 19(1):19-21.
21王潇,金晶,陶凉,等.错过最佳手术时机永存动脉干患者的外科治疗.中国胸心血管外科临床杂志, 2013, 20(3):269-272.