混合手术对双心室修复术后肺动脉直径和右心室负荷的影响,Journal of Cardiothoracic Surgery

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混合手术对双心室修复术后肺动脉直径和右心室负荷的影响
Journal of Cardiothoracic Surgery ( IF 1.5 ) Pub Date : 2023-02-07 , DOI: 10.1186/s13019-023-02162-z
Sebastian Uhl ₁ , Philippe Grieshaber ₂ , Raoul Arnold ₁ , Tsvetomir Loukanov ₂ , Matthias Gorenflo ₁

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导管支架置入术和双侧肺动脉束带术的混合手术为具有复杂先天性心脏缺陷的高危新生儿提供了一种旨在修复双心室的临时方法。这个过程也可能对导致右心室压力负荷的带后肺动脉狭窄产生负面影响。在 2010 年至 2021 年期间，我们确定了 5 名患有主动脉弓中断和复杂先天性心脏病的患者，他们接受了混合手术和分期双心室修复（“混合组”）。其他 7 例主动脉弓中断的病例在新生儿期得到矫正，未进行混合手术（“非混合组”）。记录了详细的心内和心外特征和手术过程，以及随访期间的肺部干预。肺血管大小通过左右肺动脉直径的绝对值和指数值进行评估。RV 压力通过导管插入术进行侵入性评估。在 40.7 个月的随访时间内（95% CI 26-55 个月），混合手术和分期双心室修复的病例存活率为 91%，非混合组为 100%。关于左心室功能的术后结果显示 LV 尺寸和收缩功能正常，远端主动脉弓没有相关狭窄。混合手术与剥离后局部肺动脉直径受损相关，导致右心室压力增加和需要干预（每位患者的干预次数：混合组 1.7 ± 0.95，非混合组 0.17 ± 0.41；P = 0.003）。主动脉弓中断和分期双心室修复的高危病例的混合手术显示出良好的术后效果，围手术期死亡率低，左心室功能正常。由于相关肺动脉狭窄和右心室压力负荷的潜在风险，后续检查不仅要关注左心，还要关注右心。

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Impact of hybrid procedure on pulmonary arterial dimensions and right ventricular load after biventricular repair

Hybrid procedure with ductal stenting and bilateral pulmonary banding offers a temporary approach in high-risk neonates with complex congenital heart defects aiming biventricular repair. This procedure may also have negative impact concerning post-banding pulmonary stenosis resulting in right ventricular pressure load. Between 2010 and 2021 we identified 5 patients with interrupted aortic arch and complex congenital heart defect who underwent hybrid procedure and staged biventricular repair (“hybrid-group”). Other 7 cases with interrupted aortic arch were corrected in the neonatal phase without hybrid procedure (“nonhybrid-group”). Detailed intra- and extracardiac features and surgical procedures were documented as well as pulmonary interventions during follow up. Pulmonary vessel size was assessed by diameter of left and right pulmonary artery in absolute and indexed values. RV pressure was evaluated invasively via catheterization. Survival in cases with hybrid procedure and staged biventricular repair was 91% for a follow-up time of 40.7 months (95% CI 26–55 months) and 100% in the non-hybrid-group. Postoperative results concerning left ventricular function showed normal LV dimensions and systolic function without relevant stenosis on distal aortic arch. Hybrid procedure was associated with impaired local pulmonary arterial diameter after debanding resulting in increased right ventricular pressure and need for interventions (number intervention per patient: hybrid group 1.7 ± 0.95, non-hybrid group 0.17 ± 0.41; P 0.003). Hybrid procedure in high-risk cases with interrupted aortic arch and staged biventricular repair shows good postoperative results with low perioperative mortality and normal left ventricular function. Due to potential risk of relevant pulmonary stenosis and right ventricular pressure load, follow up examinations must not only focus on left but also on the right heart.

更新日期：2023-02-07

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