同种带瓣管道用于右心室流出道重建的中期效果

摘要

目的：评价同种带瓣管道用于右心室流出道重建的中期效果。方法：回顾性收集我院2007-10至2014-07应用同种带瓣管道重建右心室流出道的122例患者资料。随诊患者术后死亡、再次手术以及同种带瓣管道衰败情况。根据手术方式分为Ross手术组（n=38）和非Ross手术组（n=84）；根据中位年龄分为≤6岁组（n=61）和>6岁组（n=61）；按带瓣管道类型分为主动脉带瓣管道组（n=21）和肺动脉管道组（n=101）；按管道直径大小分为≤19mm组（n=31）和>19mm组（n=91）。分析患者术前一般信息、不同管道类型、直径、应用病种与预后的关系。结果：平均随访（35.4±22.2）个月，有2例（1.6%）患者随访期间死亡。全部患者术后1年、5年、7年管道免于衰败率分别为94.2%、81.2%、75.4%。肺动脉同种瓣组1年、5年、7年管道免于衰败率分别为96.2%、86.1%、79.9%，主动脉同种瓣组分别为80.0%、59.7%、59.7%，两组差异有统计学意义（P=0.011）。Ross手术组1年、5年、7年管道免于衰败率分别为96.4%、89.0%、89.0%，非Ross组分别为91.3%、78.3%、67.1%，两组差异有统计学意义（P=0.045）。而患者年龄、不同管道直径、术前是否紫绀、是否二次及以上手术对于管道免于衰败率差异无统计学意义（P均＞0.05）。结论：同种带瓣管道用于先天性心脏病右心室流出道重建中期效果良好，远期防止同种带瓣管道衰败是临床进一步研究的重点。%Objective: To evaluate mid-term outcomes for the application of homograft valve conduits in right ventricular outlfow reconstruction in patients with congenital heart disease. Methods: We retrospectively studied 122 patients who received right ventricular outlfow reconstruction by homograft valve conduits application in our hospital from 2007-10 to 2014-07. The patients were divided into different sets of groups, by surgical procedure: Ross group,n=38 and Non-Ross group,n=84; by median age: ≤6 years group,n=61 and >6 years group, n=61; by the type of valve conduits: Aortic homograft group,n=21 and Pulmonary homograft group,n=101; by the diameter of conduits: ≤19 mm group,n=31 and >19 mm group,n=91. The relationships between pre-operative conditions, different types of conduits and diameters to the prognosis were analyzed; the post-operative death, re-operation, free homograft valve conduits failure rates were followed-up in all patients. Results: The average follow-up time was (35.4 ± 22.2) months and 2/122 (1.6%) patients died during that period, the overall free conduits failure rates at 1, 5 and 7 years post-operation were 94.2%, 81.2% and 75.4% respectively. The free conduits failure rates in Pulmonary homograft group at 1, 5, 7 years post-operation were 96.2%, 86.1%,79.9% and in Aortic homograft group were 80.0%, 59.7%, 59.7% respectively,P=0.011; in Ross group were 96.4%, 89.0%, 89.0% and in Non-Ross group were 91.3%, 78.3%, 67.1% respectively,P=0.045. While the age, conduits diameter, cyanosis and re-operation had no statistical meaning to free conduits failure rates, allP>0.05. Conclusion: Application of homograft valve conduits had good mid-term outcomes in right ventricular outflow reconstruction in patients with congenital heart disease, while the long-term effects should be further emphasized in clinical practice.