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Abstract：
UNASSIGNED: Adults with unrepaired tetralogy of Fallot (ToF) are common in developing countries. Long-term overload of the right ventricle places adult patients at risk for postoperative right heart failure after primary repair, which contributes to morbidity and mortality. The effect of pulmonary valve replacement (PVR) in reducing postoperative morbidity and mortality in adults has never been validated.
UNASSIGNED: We conducted a retrospective cohort study in adults (age ≥18 years) with ToF undergoing primary repair from January 2014 to December 2019 at our institution. Patients were divided into three groups according to techniques used to enlarge the right ventricle outflow tract (RVOT). Baseline variables and perioperative outcomes were collected. The primary endpoint was operative mortality. Secondary endpoints were incidences of right heart failure and stage 3 acute kidney injury (AKI).
UNASSIGNED: A total of 56 patients were enrolled (mean age 41.5±11.7 years, 30 females, 53.6%). They were divided into three groups designated as the following: TA-PVR group for trans-annular patch enlargement with PVR; TA group for trans-annulus patch enlargement without PVR; and group AP for annulus preservation. Four patients (7.1%) died postoperatively, all due to right heart failure. All twelve patients in the TA-PVR group survived. There was no significant difference in mortalities among groups. Ten patients (17.9%) developed right heart failure after surgery with no significant difference among groups. Three patients (5.4%) developed stage 3 AKI after surgery, none belonging to the TA-PVR group, however, not statistically significant.
UNASSIGNED: Right heart failure is a common complication after primary repair of adult ToF. Trans-annulus patch enlargement should be cautiously selected in this population. PVR with trans-annulus patch enlargement may be a promising technique to protect against postoperative right heart failure and mortality when annulus preservation is not feasible.
UNASSIGNED: We conducted a retrospective cohort study in adults (age ≥18 years) with ToF undergoing primary repair from January 2014 to December 2019 at our institution. Patients were divided into three groups according to techniques used to enlarge the right ventricle outflow tract (RVOT). Baseline variables and perioperative outcomes were collected. The primary endpoint was operative mortality. Secondary endpoints were incidences of right heart failure and stage 3 acute kidney injury (AKI).
UNASSIGNED: A total of 56 patients were enrolled (mean age 41.5±11.7 years, 30 females, 53.6%). They were divided into three groups designated as the following: TA-PVR group for trans-annular patch enlargement with PVR; TA group for trans-annulus patch enlargement without PVR; and group AP for annulus preservation. Four patients (7.1%) died postoperatively, all due to right heart failure. All twelve patients in the TA-PVR group survived. There was no significant difference in mortalities among groups. Ten patients (17.9%) developed right heart failure after surgery with no significant difference among groups. Three patients (5.4%) developed stage 3 AKI after surgery, none belonging to the TA-PVR group, however, not statistically significant.
UNASSIGNED: Right heart failure is a common complication after primary repair of adult ToF. Trans-annulus patch enlargement should be cautiously selected in this population. PVR with trans-annulus patch enlargement may be a promising technique to protect against postoperative right heart failure and mortality when annulus preservation is not feasible.
摘要：
■患有未修复的法洛四联症（ToF）的成年人在发展中国家很常见。长期右心室超负荷使成人患者在初次修复后有术后右心衰竭的风险，这有助于发病率和死亡率。肺动脉瓣置换术（PVR）在降低成人术后发病率和死亡率方面的作用从未得到证实。
■我们在2014年1月至2019年12月在我们机构接受ToF初级修复的成人（年龄≥18岁）中进行了一项回顾性队列研究。根据扩大右心室流出道（RVOT）的技术将患者分为三组。收集基线变量和围手术期结果。主要终点是手术死亡率。次要终点是右心衰竭和3期急性肾损伤(AKI)的发生率。
■共纳入56例患者（平均年龄41.5±11.7岁，30名女性,53.6%）。将其分为以下三组：TA-PVR组，用于PVR的跨环斑块扩大；TA组，用于无PVR的跨环斑块扩大；AP组，用于环保存。4例患者（7.1%）术后死亡，都是因为右心衰竭.TA-PVR组的所有12名患者均存活。各组死亡率无显著差异。10例（17.9%）患者术后发生右心衰竭，组间无显著差异。3例患者（5.4%）在手术后发展为3期AKI，不属于TA-PVR组，然而,没有统计学意义。
■右心衰竭是成人ToF初次修复后常见的并发症。在该人群中，应谨慎选择跨环补片扩大。在不可行的保留环的情况下，具有跨环补片扩大的PVR可能是一种有前途的技术，可以防止术后右心力衰竭和死亡。
■我们在2014年1月至2019年12月在我们机构接受ToF初级修复的成人（年龄≥18岁）中进行了一项回顾性队列研究。根据扩大右心室流出道（RVOT）的技术将患者分为三组。收集基线变量和围手术期结果。主要终点是手术死亡率。次要终点是右心衰竭和3期急性肾损伤(AKI)的发生率。
■共纳入56例患者（平均年龄41.5±11.7岁，30名女性,53.6%）。将其分为以下三组：TA-PVR组，用于PVR的跨环斑块扩大；TA组，用于无PVR的跨环斑块扩大；AP组，用于环保存。4例患者（7.1%）术后死亡，都是因为右心衰竭.TA-PVR组的所有12名患者均存活。各组死亡率无显著差异。10例（17.9%）患者术后发生右心衰竭，组间无显著差异。3例患者（5.4%）在手术后发展为3期AKI，不属于TA-PVR组，然而,没有统计学意义。
■右心衰竭是成人ToF初次修复后常见的并发症。在该人群中，应谨慎选择跨环补片扩大。在不可行的保留环的情况下，具有跨环补片扩大的PVR可能是一种有前途的技术，可以防止术后右心力衰竭和死亡。
