同种带瓣管道重建右室流出道单中心13年临床分析  

Application status of right ventricular outflow tract reconstruction with valved homograft conduits:13 years’clinical analysis of a single center

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7期1019-1024,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：目的分析阜外医院同种带瓣管道(valved homograft conduit,VHC)重建右室流出道近13年的临床结果,并探究VHC远期耐久性的影响因素。方法回顾性分析阜外医院2007年11月—2020年10月使用VHC重建右室流出道患者的临床资料。采用Kaplan-Meier生存曲线评估患者的生存率、免于VHC再干预率和免于VHC功能障碍率。采用Cox比例风险回归模型分析VHC功能障碍的危险因素。结果共纳入251例患者,其中男145例、女106例,中位手术年龄为6.0(0.3~67.0)岁。早期死亡5例(2.0%)。239例(95.2%)患者出院后得到有效随访,随访时间为0.3~160.0(61.3±45.4)个月。随访期间5例患者死亡,1年、6年和13年生存率分别为96.6%、95.5%和95.5%。8例患者行VHC再干预,1年、6年和13年免于VHC再干预率分别为100.0%、97.1%和82.4%。出院后共226例患者得到心脏超声随访,超声随访时间为0.2~138.0(48.5±40.5)个月。随访期间,46例(20.4%)患者出现VHC功能障碍,1年、5年、10年免于VHC功能障碍率分别为92.6%、79.6%和59.3%。单因素Cox回归分析提示,年龄<6岁和VHC直径<19 mm是VHC功能障碍的危险因素(P=0.029、0.026),但多因素回归分析仅发现年龄<6岁是VHC功能障碍的独立危险因素(P=0.034)。结论VHC重建右室流出道的近期和远期临床结果均非常满意,且VHC的远期耐久性也较好。此外,年龄<6岁是VHC功能障碍的独立危险因素。Objective To evaluate the clinical outcome of valved homograft conduits(VHC)used for right ventricular outflow tract(RVOT)reconstruction in Fuwai Hospital in recent 13 years,and explore the factors influencing the long-term durability of VHC.Methods Clinical data of patients using VHC for RVOT reconstruction in Fuwai Hospital from November 2007 to October 2020 were retrospectively analyzed.The Kaplan-Meier survival curve was used to evaluate survival,VHC reintervention and VHC dysfunction.Cox proportional risk regression model was used to analyze the risk factors for VHC dysfunction.Results Finally 251 patients were enrolled,including 145 males and 106 females.The median age at surgery was 6.0(0.3-67.0)years.Early death occurred in 5(2.0%)patients.The follow-up was available for 239(95.2%)patients,with the follow-up time of 0.3-160.0(61.3±45.4)months.Five patients died during the follow-up,and the 1-year,6-year,and 13-year survival rates were 96.6%,95.5%and 95.5%,respectively.Eight patients received VHC reintervention during the follow-up,and freedom rates from VHC reintervention were 100.0%,97.1%and 82.4%at 1 year,6 years and 13 years,respectively.A total of 226 patients were followed up by echocardiography after discharge,with the follow-up time of 0.2-138.0(48.5±40.5)months.During the follow-up,46(20.4%)patients developed VHC dysfunction,and freedom rates from VHC dysfunction at 1 year,5 years,and 10 years were 92.6%,79.6%and 59.3%,respectively.Univariate Cox regression analysis showed that age<6 years and VHC diameter<19 mm were risk factors for VHC dysfunction(P=0.029,0.026),but multivariate regression analysis only indicated that age<6 years was an independent risk factor for VHC dysfunction(P=0.034).Conclusion The early and late outcomes of VHC used for RVOT reconstruction are satisfactory,and the long-term durability of VHC is also optimal.In addition,age<6 years is an independent risk factor for VHC dysfunction.

关 键 词：同种带瓣管道 右室流出道 远期耐久性 危险因素 

分 类 号：R654.2[医药卫生—外科学]