完全生物可降解室间隔缺损封堵器植入的中期随访结果  

Midterm follow-up results of implantation of a fully biodegradable ventricular septal defect occluder

作　　者：龚雪阳 杨一峰[1] 赵天力[1] 胡世军 张伟志[1] GONG Xueyang;YANG Yifeng;ZHAO Tianli;HU Shijun;ZHANG Weizhi(Department of Cardiovascular Surgery,Second Xiangya Hospital,Central South University,Changsha 410011,China)

机构地区：[1]中南大学湘雅二医院心血管外科,长沙410011

出　　处：《中南大学学报（医学版）》2024年第5期795-801,共7页Journal of Central South University ：Medical Science

基　　金：湖南省自然科学基金(2022JJ70062)。

摘　　要：目的:室间隔缺损(ventricular septal defect,VSD)是一种常见的先天性心脏畸形,改良封堵器、选择更优的路径等方法拓展了VSD封堵术的适应证并降低了相关并发症发生率,其中完全生物可降解封堵器的使用有望彻底解决VSD封堵造成的传导阻滞的问题。本研究旨在比较完全生物可降解封堵器与金属封堵器在经食道超声心动图引导下胸骨下段小切口VSD封堵术的中期随访结果,并分析术后发生心电图及瓣膜异常的危险因素。方法:回顾2019年1月1日至11月7日在中南大学湘雅二医院进行VSD封堵术的27例患者术后3年内的随访资料,通过心电图及超声心动图结果评估手术的安全性及有效性,并通过Logistic回归分析探讨术后发生心电图及瓣膜异常的危险因素。结果:分别有12例和15例患者采用金属封堵器和完全生物可降解封堵器进行VSD封堵,患者随访期间均存活,未发生房室传导阻滞、较大残余分流、封堵器过快吸收、明显瓣膜反流等严重并发症。金属封堵器组与完全生物可降解封堵器组术后1、2、3年的心电图和彩色多普勒超声检查结果比较,差异无统计学意义(均P>0.05)。VSD封堵器大小是影响术后2、3年三尖瓣反流的危险因素,封堵器大小与缺损大小的差值是影响术后2年三尖瓣反流的危险因素(P<0.05)。结论:完全生物可降解封堵器在小型VSD封堵中的中期安全性和有效性较高,并具有与传统镍钛合金封堵器相同的术后效果。Objective:Ventricular septal defect(VSD)is a prevalent congenital cardiac anomaly.By enhancing the occluder design and optimizing procedural approaches,the indications for VSD closure can be broadened while minimizing associated complications.The utilization of fully biodegradable occluder holds promising potential in resolving conduction block issues encountered during VSD closure.This study aims to compare the results of the fully biodegradable occluder with the metal occluder in transoesophageal echocardiography-guided VSD closure via lower sternal level minor incision at the interim follow-up,and to find risk factors for the occurrence of electrocardiographic and valvular abnormalities postoperatively.Methods:We reviewed the postoperative and 3-year follow-up data of all patients who underwent the randomized controlled study of VSD closure from January 1 to November 7,2019 in the Second Xiangya Hospital of Central South University.The safety and efficacy of the procedure were assessed and compared between the 2 groups by electrocardiogram and echocardiography results,and the risk factors for the occurrence of postoperative electrocardiogram and valve abnormalities were studied with Logistic regression analysis.Results:Twelve and fifteen patients underwent VSD closure with the metallic occluder and the fully biodegradable occluder,respectively.All patients survived during the follow-up period without major complications such as atrioventricular block,significant residual shunt,too rapid absorption of the occluder,and significant valvular regurgitation.There were no significant differences in the results of electrocardiograph and color Doppler ultrasonography the metal occluder group and the fully biodegradable occluder group 1,2,and 3 years after operation(all P>0.05).The size of the occluder were risk factors for tricuspid regurgitation at 2 and 3 years postoperatively,and the difference between the occluder size and the VSD defect size were risk factors for tricuspid regurgitation at 2 years postoperatively(

关 键 词：室间隔缺损封堵术 完全生物可降解室间隔缺损封堵器 金属室间隔缺损封堵器 瓣膜反流 

分 类 号：R654.2[医药卫生—外科学]