Right Ventricular Outflow Tract Reconstruction in Infant Truncus Arteriosus: A 37-year Experience

被引:18
作者
Herrmann, Jeremy L.
Larson, Emilee E.
Mastropietro, Christopher W.
Rodefeld, Mark D.
Turrentine, Mark W.
Nozaki, Ryoko
Brown, John W.
机构
[1] Indiana Univ, Sch Med, Div Thorac & Cardiovasc Surg, Indianapolis, IN USA
[2] Indiana Univ Hlth, Riley Hosp Children, Sect Congenital Cardiac Surg, Indianapolis, IN USA
[3] Indiana Univ, Sch Med, Dept Pediat, Div Crit Care, Indianapolis, IN 46202 USA
[4] Jikei Univ, Sch Med, Dept Cardiac Surg, Tokyo, Japan
[5] Univ Tsukuba, Dept Surg, Fac Med, Ibaraki, Japan
关键词
INTERRUPTED AORTIC-ARCH; CONTEGRA CONDUIT; RISK-FACTORS; NEONATAL REPAIR; PULMONARY; HOMOGRAFTS; OUTCOMES; VALVE; REINTERVENTION; CHILDREN;
D O I
10.1016/j.athoracsur.2019.11.023
中图分类号
R5 [内科学];
学科分类号
1002 ; 100201 ;
摘要
Background. Multiple conduits for right ventricular outflow tract reconstruction exist, although the ideal conduit that maximizes outcomes remains controversial. We evaluated long-term outcomes and compared conduits for right ventricular outflow tract reconstruction in children with truncus arteriosus. Methods. Records of patients who underwent truncus arteriosus repair at our institution between 1981 and 2018 were retrospectively reviewed. Primary outcomes included survival and freedom from catheter reintervention or reoperation. Secondary analyses evaluated the effect of comorbidity, operation era, conduit type, and conduit size. Results. One hundred patients met inclusion criteria. Median follow-up time was 15.6 years (interquartile range, 5.3-22.2). Actuarial survival at 30 days, 5 years, 10 years, and 15 years was 85%, 72%, 72%, and 68%, respectively. Early mortality was associated with concomitant interrupted aortic arch (hazard ratio, 5.4; 95% confidence interval, 1.7-17.4; P = .005). Median time to surgical reoperation was 4.6 years (interquartile range, 2.9-6.8; n = 58). Right ventricle to pulmonary artery continuity was established with an aortic homograft (n = 14), pulmonary homograft (n = 41), or bovine jugular vein conduit (n = 36) in most cases. Multivariate analysis revealed longer freedom from reoperation with the bovine jugular vein conduit compared with the aortic homograft (hazard ratio, 3.1; 95% confidence interval, 1.3-7.7; P = .02) with no difference compared with the pulmonary homograft. Larger conduit size was associated with longer freedom from reoperation (hazard ratio, 0.7; 95% confidence interval, 0.6-0.9; P <.001). Conclusions. The bovine jugular vein conduit is a favorable conduit for right ventricular outflow tract reconstruction in patients with truncus arteriosus. Concomitant interrupted aortic arch is a risk factor for early mortality. (C) 2020 by The Society of Thoracic Surgeons.
引用
收藏
页码:630 / 637
页数:8
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