Objective

The ideal management of peripheral pulmonary artery stenosis is still controversial. We adopted a primary surgical approach to this complex lesion with excellent early outcomes. In this study, we analyzed our late outcomes.

Methods

We performed a retrospective review of 91 patients with biventricular anatomy who underwent peripheral pulmonary artery reconstruction from March 2008 to July 2020. Our surgical approach included either a single-stage complete repair through median sternotomy or a 2-stage repair through sternotomy/left thoracotomy, depending on the degree of distal involvement of the left pulmonary artery branches.

Results

Median age was 26 months. Syndromic etiology was established in 54 patients (59.3%) versus nonsyndromic etiology in 37 patients (40.7%). Single-stage repair was achieved in 68 patients (74.7%). There were 2 (2.2%) in-hospital mortalities. The mean right ventricular to aortic systolic pressure ratio decreased from 1.07 ± 0.20 preoperatively to 0.32 ± 0.07 immediately postoperatively (P < .001), representing a 70.1% reduction. At 1-year postoperative catheterization, the mean right ventricular to aortic systolic pressure ratio was 0.28 ± 0.05 (P < .001 compared with immediately postoperative value). With a median follow-up of 68 months (IQR, 39-117.5 months), there was no late mortality after discharge. All patients were active and asymptomatic on the most recent follow-up. There were no early or late reinterventions on pulmonary arteries.

Conclusions

Late outcomes of surgical reconstruction of peripheral pulmonary arteries are excellent and durable in various pathologies (syndromic and nonsyndromic) with a significant reduction in right ventricular to aortic systolic pressure ratio, low mortality, and no reintervention.

中文翻译：

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外周肺动脉手术重建的晚期结果

客观的

外周肺动脉狭窄的理想治疗方法仍存在争议。我们对这种复杂的病变采用了主要的手术方法，早期结果非常好。在这项研究中，我们分析了我们的晚期结果。

方法

我们对 2008 年 3 月至 2020 年 7 月期间接受外周肺动脉重建的 91 名双心室解剖患者进行了回顾性研究。我们的手术方法包括通过胸骨正中切开术进行单期完全修复或通过胸骨切开术/左开胸术进行二期修复，视左肺动脉分支远端受累程度而定。

结果

中位年龄为 26 个月。54 名患者 (59.3%) 确定了综合征病因，而 37 名患者 (40.7%) 确定了非综合征病因。68 名患者（74.7%）实现了单期修复。有 2 人 (2.2%) 住院死亡。平均右心室与主动脉收缩压比从术前的 1.07 ± 0.20 降至术后即刻的 0.32 ± 0.07 ( P  < .001)，降低了 70.1%。术后 1 年插管时，平均右心室与主动脉收缩压比为 0.28 ± 0.05（P < .001 与术后即刻值相比）。中位随访时间为 68 个月（IQR，39-117.5 个月），出院后无晚期死亡率。在最近的随访中，所有患者都活跃且无症状。没有对肺动脉进行早期或晚期再干预。

结论

外周肺动脉手术重建的晚期结果在各种病理（综合征性和非综合征性）中都非常好且持久，右心室与主动脉收缩压比显着降低，死亡率低，无需再干预。