Homograft durability after correction of pulmonary atresia and ventricular septal defect with or without systemic pulmonary collateral arteriesCentral MessagePerspective

JTCVS Open

Jamie L.R. Romeo, MD, PHD¹  M. Mostafa Mokhles, MD, PhD²  Ingrid van Beynum, MD, PhD³  Pieter C. van de Woestijne, MD³  Ad J.J.C. Bogers, MD, PhD³  Maarten Witsenburg, MD, PhD⁴ 

[1] Address for reprints: Pieter C. van de Woestijne, MD, ’s Gravendijkwal 230, 3015 CE Rotterdam, The Netherlands.;Department of Cardiology, Erasmus University Medical Centre, Rotterdam, The Netherlands;Department of Cardiothoracic Surgery, Erasmus University Medical Centre, Rotterdam, The Netherlands;Department of Pediatric Cardiology, Erasmus University Medical Centre, Rotterdam, The Netherlands;

关键词: congenital heart disease;    homograft;    pulmonary atresia;    right ventricular outflow tract reconstruction;   

DOI  :  

来源: DOAJ

【 摘 要 】

Background: Pulmonary atresia and ventricular septal defect (PA-VSD), with or without systemic pulmonary collateral arteries (SPCAs), represents a complex anatomic and surgical spectrum of congenital heart disease. Currently, there is limited evidence on homograft durability after complete correction, which potentially could be affected by anatomic differences in pulmonary vasculature. Methods: This retrospective single-center study included all 69 consecutive PA-VSD patients (46 with SPCAs, 23 without SPCAs) operated on between 1978 and 2018. The primary interest was in homograft durability after complete repair. Longitudinal echocardiographic homograft function and right ventricular systolic pressure were analyzed with linear mixed-effects models. Results: The median duration of follow-up was 20 years. Of the 46 patients with SPCAs, 37 (80.4%) underwent biventricular correction at a median age of 2.7 years (interquartile range [IQR], 1.8-6.3 years). Two patients are currently awaiting unifocalization and correction. All 23 patients without SPCAs underwent successful complete correction at a median age of 1.6 years (IQR, 1.1-3.6 years). Freedom from any reintervention after 20 years was 15%. When a homograft was used during correction, freedom from homograft replacement after 20 years was comparable in the 2 groups (P = .925), at 32 ± 11% in the SPCA group and 32 ± 13% in the non-SPCA group. Indications for homograft replacement were isolated stenosis (n = 7; 46.7%), isolated regurgitation (n = 3; 20.0%), and mixed stenosis and regurgitation (n = 5; 33.3%) in the SPCA group and isolated stenosis (n = 8; 88.9%) and stenosis and regurgitation (n = 1; 11.1%) in the non-SPCA group. Peak homograft gradient was significantly (P = .0003) higher in patients without SPCA, with a comparable rate of progression in the 2 groups. However, the prevalence of severe pulmonary regurgitation (PR) was higher in patients with SPCAs, estimated at 35% at 10 years, compared with 15% in patients without SPCAs. Conclusions: Homografts used for right ventricular outflow tract reconstruction in patients with PA-VSD, either with or without SPCAs, have similar limited durability. Repeated reintervention is common, and careful follow-up with attention to severe PR is warranted.

【 授权许可】

Unknown