背景:某些类型的复杂先天性心脏缺损的修复可能需要右心室-肺动脉(RV-PA)导管。使用Ozaki主动脉瓣新缓冲术(AVNeo)技术,带瓣膜的RV-PA导管在Dacron移植物内构造有Ozaki瓣膜。本研究旨在评估Ozaki瓣膜RV-PA导管的短期结果。
方法:从2019年11月至2023年12月,共有22名患者接受了Ozaki瓣膜RV-PA导管。中位年龄为12岁(四分位距[IQR],5.5-21),中位体重为35kg(IQR,15.8-48.5)。导管用于18岁以下的16例患者(72.7%)。导管放置的适应症包括:矫正大动脉转位的解剖修复,室间隔缺损/肺动脉狭窄,导管更换,伴有相关异常的肺动脉闭锁,肺动脉瘤伴肺动脉瓣发育不良,法洛四联症与穿过右心室流出道的冠状动脉,生物人工肺动脉瓣反流,和风湿性心脏病。12例患者使用天然心包用于Ozaki瓣膜,10例患者使用牛心包。导管尺寸范围为18mm至30mm。
结果:重症监护病房的中位住院时间为4(IQR,2-6天),中位住院时间为9天(IQR,5.5-13.5)天。有两个围手术期死亡率(9.1%),均与导管无关。中位随访时间为12.3(IQR,4.43-21.2)个月。导管没有感染性心内膜炎。整个导管的中值峰值梯度为22mmHg(范围为0-44mm),在后续行动中,所有人都能胜任琐碎的反流。
结论:由于低成本,创建Ozaki阀门管道是一个有吸引力的选择,再现性,和良好的血液动力学。需要更长期的研究来确认耐久性。
BACKGROUND: The repair of certain types of complex congenital cardiac defects may require a right ventricle-pulmonary artery (RV-PA) conduit. Using the Ozaki Aortic valve neocuspidization (AVNeo)technique, a valved RV-PA conduit was constructed with an Ozaki valve inside a Dacron graft. This study aims to evaluate the short-term outcome of the Ozaki valved RV-PA conduit.
METHODS: A total of 22 patients received the Ozaki valved RV-PA conduit from November 2019 until December 2023. The median age was 12 years (interquartile range [IQR], 5.5-21), median body weight was 35 kg (IQR, 15.8-48.5). The conduit was used in 16 patients (72.7%) under 18 years of age. Indications for conduit placement included: anatomic repair of corrected transposition of the great arteries, ventricular septal defect/pulmonary stenosis, conduit replacement, pulmonary atresia with associated anomalies, pulmonary artery aneurysm with dysplastic pulmonary valve, tetralogy of Fallot with coronary artery crossing the right ventricular outflow tract, bioprosthetic pulmonary valve regurgitation, and rheumatic heart disease. Native pericardium was used for the Ozaki valve in 12 patients and bovine pericardium for 10 patients. Conduit sizes ranged from 18 mm to 30 mm.
RESULTS: The median intensive care unit stay was 4 (IQR, 2-6) days and the median hospital stay was 9 (IQR, 5.5-13.5) days. There were two perioperative mortalities (9.1%) both unrelated to the conduit. The median follow-up was 12.3 (IQR, 4.43-21.2) months. There was no infective endocarditis of the conduit. The median peak gradient across the conduit was 22 mm Hg (range 0-44 mm), and all were competent with trivial regurgitation on follow up.
CONCLUSIONS: Creation of an Ozaki valved conduit is an attractive option due to low cost, reproducibility, and excellent hemodynamics. Longer-term studies are needed to confirm the durability.