PDF(Pubmed)
Abstract：
BACKGROUND: Pulmonary regurgitation (PR) remains a common sequela in patients following surgically corrected TOF, and may lead to progressive right ventricle dilatation and dysfunction. The conventional approach of redo-sternotomy for pulmonary valve replacement (PVR) is associated with increased operative time as well as risks of bleeding and injury to the heart and great vessels. Thus, left anterior mini-thoracotomy has become an alternative approach in eliminating the risks of redo-sternotomy in these patients. This series aimed to determine the outcomes of minimally invasive pulmonary valve replacement after surgical TOF correction.
METHODS: A retrospective analysis was conducted on 24 patients with severe PR post-surgical TOF correction who underwent left anterior mini-thoracotomy PVR in Penang General Hospital from January 2021 to January 2023.
RESULTS: The median age was 23.5 years (I.Q.range 17.6-36.3), with a male:female ratio of 1:4. Majority of patients had mild to moderate symptoms prior to surgery and 19 patients (79.1%) were on regular diuretics medication. All patients had severe free-flow PR with evidence of right ventricular dilatation and dysfunction. Magnetic Resonance Imaging and computed tomography of pulmonary artery were performed prior to surgery. Minimally invasive PVR was performed on all patients via left upper anterior mini-thoracotomy and femoral-femoral bypass without cardioplegic arrest. The operative time and cardiopulmonary bypass time were 208 (I.Q.range 172-324) and 98.6 minutes(I.Q.range 87.4-152.4) respectively. The time to wean off inotropes postoperatively was 6.2 hours (I.Q.range1.4-14.8), and no postoperative arrhythmia and chest re-exploration were reported. Most patients stayed in Intensive Care Unit (ICU) for 10.8 hours (I.Q.range 8.4-36.5), and the total hospital stay was 4.2 days (I.Q.range 3.4-7.6). 2 patients (11.1%) required blood transfusion postoperative. There was no paravalvular leak and no mortality during the follow-up period of up to 28 months.
CONCLUSIONS: Minimally invasive PVR after surgical correction of TOF is a safe alternative to the conventional redo-sternotomy approach in patients with favorable anatomy. This approach is able to reduce the risks associated with redo-sternotomy, particularly bleeding and injury to mediastinal structures, with the additional benefit of expedited recovery and hospital discharge. Our series has shown a safe and efficient approach in these patients with favorable outcomes.
METHODS: A retrospective analysis was conducted on 24 patients with severe PR post-surgical TOF correction who underwent left anterior mini-thoracotomy PVR in Penang General Hospital from January 2021 to January 2023.
RESULTS: The median age was 23.5 years (I.Q.range 17.6-36.3), with a male:female ratio of 1:4. Majority of patients had mild to moderate symptoms prior to surgery and 19 patients (79.1%) were on regular diuretics medication. All patients had severe free-flow PR with evidence of right ventricular dilatation and dysfunction. Magnetic Resonance Imaging and computed tomography of pulmonary artery were performed prior to surgery. Minimally invasive PVR was performed on all patients via left upper anterior mini-thoracotomy and femoral-femoral bypass without cardioplegic arrest. The operative time and cardiopulmonary bypass time were 208 (I.Q.range 172-324) and 98.6 minutes(I.Q.range 87.4-152.4) respectively. The time to wean off inotropes postoperatively was 6.2 hours (I.Q.range1.4-14.8), and no postoperative arrhythmia and chest re-exploration were reported. Most patients stayed in Intensive Care Unit (ICU) for 10.8 hours (I.Q.range 8.4-36.5), and the total hospital stay was 4.2 days (I.Q.range 3.4-7.6). 2 patients (11.1%) required blood transfusion postoperative. There was no paravalvular leak and no mortality during the follow-up period of up to 28 months.
CONCLUSIONS: Minimally invasive PVR after surgical correction of TOF is a safe alternative to the conventional redo-sternotomy approach in patients with favorable anatomy. This approach is able to reduce the risks associated with redo-sternotomy, particularly bleeding and injury to mediastinal structures, with the additional benefit of expedited recovery and hospital discharge. Our series has shown a safe and efficient approach in these patients with favorable outcomes.
摘要：
背景：肺返流（PR）仍然是手术矫正TOF后患者的常见后遗症，并可能导致进行性右心室扩张和功能障碍。用于肺动脉瓣置换术（PVR）的重新胸骨切开术的常规方法与手术时间增加以及出血和心脏和大血管损伤的风险有关。因此，在这些患者中,左前路微型开胸手术已成为消除再行胸骨切开术风险的替代方法.本系列旨在确定手术TOF矫正后微创肺动脉瓣置换术的结果。
方法：回顾性分析2021年1月至2023年1月在槟城总医院行左前路小切口PVR的24例重度PR术后TOF矫正患者。
结果：中位年龄为23.5岁（智商范围17.6-36.3），男女比例为1:4。大多数患者在手术前有轻度至中度症状，有19例患者（79.1％）接受常规利尿剂治疗。所有患者均有严重的自由流量PR，有右心室扩张和功能障碍的证据。术前进行肺动脉磁共振成像和计算机断层扫描。所有患者均通过左上前路小切口和股-股分流术进行微创PVR，而没有心脏停搏。手术时间和体外循环时间分别为208（智商范围172-324）和98.6分钟（智商范围87.4-152.4）。术后断奶时间为6.2小时（智商范围1.4-14.8），无术后心律失常和胸部再探查报告。大多数患者在重症监护病房（ICU）停留10.8小时（智商范围8.4-36.5），总住院时间为4.2天（智商范围3.4-7.6）。2例(11.1%)患者术后需要输血。在长达28个月的随访期间，没有瓣膜旁漏和死亡。
结论：在具有良好解剖结构的患者中，TOF手术矫正后的微创PVR是传统胸骨重行切开术的安全替代方法。这种方法能够降低与重做胸骨切开术相关的风险，尤其是纵隔结构的出血和损伤，还有加速康复和出院的额外好处。我们的系列已显示出在这些患者中安全有效的方法，具有良好的预后。
方法：回顾性分析2021年1月至2023年1月在槟城总医院行左前路小切口PVR的24例重度PR术后TOF矫正患者。
结果：中位年龄为23.5岁（智商范围17.6-36.3），男女比例为1:4。大多数患者在手术前有轻度至中度症状，有19例患者（79.1％）接受常规利尿剂治疗。所有患者均有严重的自由流量PR，有右心室扩张和功能障碍的证据。术前进行肺动脉磁共振成像和计算机断层扫描。所有患者均通过左上前路小切口和股-股分流术进行微创PVR，而没有心脏停搏。手术时间和体外循环时间分别为208（智商范围172-324）和98.6分钟（智商范围87.4-152.4）。术后断奶时间为6.2小时（智商范围1.4-14.8），无术后心律失常和胸部再探查报告。大多数患者在重症监护病房（ICU）停留10.8小时（智商范围8.4-36.5），总住院时间为4.2天（智商范围3.4-7.6）。2例(11.1%)患者术后需要输血。在长达28个月的随访期间，没有瓣膜旁漏和死亡。
结论：在具有良好解剖结构的患者中，TOF手术矫正后的微创PVR是传统胸骨重行切开术的安全替代方法。这种方法能够降低与重做胸骨切开术相关的风险，尤其是纵隔结构的出血和损伤，还有加速康复和出院的额外好处。我们的系列已显示出在这些患者中安全有效的方法，具有良好的预后。
