同种带瓣管道重建右室流出道在Ross手术和非Ross手术后的远期耐久性  

The long-term durability of valved homograft conduit in right ventricular outflow tract reconstruction after Ross surgery and non-Ross surgery

作　　者：顿耀军 赵栋 花中东[1] 闫军[1] 李守军[1] 杨克明[1] DUN Yaojun;ZHAO Dong;HUA Zhongdong;YAN Jun;LI Shoujun;YANG Keming(Department of Cardiovascular Surgery,Fuwai Hospital,National Center for Cardiovascular Diseases,Chinese Academy of Medical Sciences,Beijing 100037,P.R.China)

机构地区：[1]中国医学科学院北京协和医学院国家心血管病中心阜外医院心血管外科,北京100037

出　　处：《中国胸心血管外科临床杂志》2023年第6期884-889,共6页Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

基　　金：中央高校基本科研业务费专项资金(3332021027)。

摘　　要：目的比较同种带瓣管道(valved homograft conduit,VHC)重建右室流出道在Ross手术和非Ross手术后的远期耐久性。方法回顾性纳入2008年1月—2020年10月阜外医院使用VHC重建右室流出道的患者,Ross手术患者为Ross组,非Ross手术患者为非Ross组。采用Kaplan-Meier生存曲线和log-rank检验评估两组患者的生存率和免于VHC再干预率。对两组完成超声随访的患者进行倾向性评分匹配分析,比较匹配后两组患者的免于VHC功能障碍率。结果共纳入患者243例,其中男142例、女101例,中位手术年龄6岁(4个月至56岁)。Ross组77例,非Ross组166例(共168例手术)。Ross组平均体外循环时间短于非Ross组[(175.4±45.6)min vs.(200.1±83.5)min,P=0.003]。非Ross组5例早期死亡患者。231例(93.1%)患者得到有效随访,平均随访时间(61.7±44.4)个月。随访期间,非Ross组5例患者死亡;Ross组和非Ross组的12年生存率分别为100.0%和93.2%(log-rank,P=0.026)。随访期间,Ross组1例和非Ross组7例患者行VHC再干预;两组患者免于VHC再干预率差异无统计学意义(log-rank,P=0.096)。Ross组73例和非Ross组147例患者出院后得到超声随访,其中45例(20.5%)患者出现VHC功能障碍。倾向性评分匹配前,Ross组VHC远期耐久性优于非Ross组(10年免于VHC功能障碍率:66.6%vs.37.1%,log-rank,P=0.025)。匹配后,Ross组和非Ross组各64例患者,匹配后两组VHC耐久性差异无统计学意义(10年免于VHC功能障碍率:76.3%vs.43.0%,log-rank,P=0.065)。亚组分析发现,在手术年龄<6岁的患者中,Ross组10年免于VHC功能障碍率高于非Ross组(71.0%vs.20.0%,log-rank,P=0.032);在手术年龄≥6岁的患者中,两组10年免于VHC功能障碍率差异无统计学意义(53.7%vs.56.7%,log-rank,P=0.218)。结论倾向性评分匹配后,VHC的远期耐久性在Ross组和非Ross组无明显差异;在手术年龄<6岁的患者中,Ross手术后VHC的远期耐久性优于非Ross手术。Objective To compare the long-term durability of valved homograft conduit(VHC)in patients with Ross and non-Ross right ventricular outflow tract(RVOT)reconstruction.Methods A total of 243 patients underwent RVOT reconstruction using VHC in Fuwai Hospital from January 2008 to October 2020 were retrospectively included.There were 142 males and 101 females,with a median age of 6 years(4 months to 56 years).Seventy-seven patients received Ross RVOT reconstruction(Ross group)and 166 patients received non-Ross RVOT reconstruction(168 surgeries,non-Ross group).The survival,reintervention-free rate and VHC dysfunction-free rate of the two groups were evaluated with the Kaplan-Meier survival curve and log-rank test.The propensity score matching analysis was performed on the two groups,and the VHC dysfunction-free rate was compared between the two groups after matching.Results The cardiopulmonary bypass time in the Ross group was shorter than that in the non-Ross group(175.4±45.6 min vs.200.1±83.5 min,P=0.003).Five patients in the non-Ross group died early after the operation.The follow-up was available in 231 patients(93.1%),with the average follow-up time of 61.7±44.4 months.During follow-up,5 patients in the non-Ross group died.The 12-year survival was 100%in the Ross group and 93.7%in the non-Ross group(log-rank,P=0.034).In addition,1 patient in the Ross group and 7 patients in the non-Ross group received VHC reintervention.There was no significant difference in the reintervention-free rate between the two groups(log-rank,P=0.096).Among the 73 patients in the Ross group and 147 patients in non-Ross group who were followed up by ultrasound after discharge,45 patients(20.5%)developed VHC dysfunction.The long-term durability of VHC in Ross group was better than that in non-Ross group(10-year VHC dysfunction-free rate:66.6%vs.37.1%,log-rank,P=0.025).In subgroup analysis,the 10-year freedom from VHC dysfunction in Ross group was higher than that in non-Ross group(71.0%vs.20.0%,log-rank,P=0.032)among patients aged<6 years

关 键 词：同种带瓣管道 右室流出道 ROSS手术 非Ross手术 远期耐久性 

分 类 号：R654.2[医药卫生—外科学]