目的:在本研究中,我们的目的是比较接受初次导管支架置入单室心脏的婴儿和接受系统性肺分流术的婴儿.
方法:对所有在2009年至2022年期间接受导管支架置入术或外科全身肺分流术的单室心脏和导管依赖性肺血流的婴儿进行了初步缓解。比较导管支架置入或全身肺分流术后的结果,包括生存率,重新干预的可能性和达到II期缓解的可能性。
结果:共评估了130例患者,包括49个导管支架和81个全身到肺分流。最常见的主要诊断是27例三尖瓣闭锁,其次是19例室间隔完整的肺动脉闭锁。有相当的医院死亡率(2.0%支架vs3.7%手术,p=0.91)组间,但重症监护病房住院时间较短(中位数为1天vs7天,p<0.01)和较短的住院时间(中位数7天vs17天,p<0.01)在初始导管支架置入的患者中观察到,与全身到肺分流术相比。然而,急性手术相关并发症在导管支架置入患者中更常见,与全身向肺分流的患者相比(20.4%vs6.2%,p=0.01),10例患者在最初的导管支架后需要进行分流手术。在导管支架置入术和全身至肺分流术之间达到II期的累积发生率相似(12个月时88.0vs90.6%,p=0.735)。II期的肺动脉指数(中位数194vs219mm2/m2,p=0.93)在导管支架置入和全身肺分流术患者之间相似。然而,左右肺动脉指数的比值(0.69(0.45-0.95)vs0.86(0.51-0.84),p=0.015)在手术分流生理达到II期的患者中更高,对比患者的导管支架生理。
结论:在单室心脏婴儿的初始导管支架术后,生存率相当,术后恢复时间较短,但观察到更多的急性支架功能障碍和较低的左肺动脉发育,与急性分流功能障碍相比。侵入性较小的程序和较短的住院时间是以更多的支架再干预为代价的。
OBJECTIVE: In this study, we aimed to compare infants with univentricular hearts who underwent an initial ductus stenting to those receiving a surgical systemic-to-pulmonary shunt (SPS).
METHODS: All infants with univentricular heart and ductal-dependent pulmonary blood flow who underwent initial palliation with either a ductus stenting or a surgical SPS between 2009 and 2022 were reviewed. Outcomes were compared after ductus stenting or SPS including survival, probability of re-interventions and the probability to reach stage II palliations.
RESULTS: A total of 130 patients were evaluated, including 49 ductus stenting and 81 SPSs. The most frequent primary diagnosis was tricuspid atresia in 27, followed by pulmonary atresia with intact ventricular septum in 19 patients. There was comparable hospital mortality (2.0% stent vs 3.7% surgery, P = 0.91) between the groups, but shorter intensive care unit stay (median 1 vs 7 days, P < 0.01) and shorter hospital stay (median 7 vs 17 days, P < 0.01) were observed in patients with initial ductus stenting, compared to those with SPS. However, acute procedure-related complications were more frequently observed in patients with ductus stenting, compared with those with SPS (20.4 vs 6.2%, P = 0.01), and 10 patients needed a shunt procedure after the initial ductus stent. The cumulative incidence of reaching stage II was similar between ductus stenting and SPS (88.0 vs 90.6% at 12 months, P = 0.735). Pulmonary artery (PA) index (median 194 vs 219 mm2/m2, P = 0.93) at stage II was similar between patients with ductus stenting and SPS. However, the ratio of the left to the right PA index [0.69 (0.45-0.95) vs 0.86 (0.51-0.84), P = 0.015] was higher in patients who reached stage II with surgical shunt physiology, compared with patients with ductus stent physiology.
CONCLUSIONS: After initial ductus stenting in infants with univentricular heart, survival is comparable and post-procedural recovery shorter, but more acute stent dysfunctions and lower development of left PA are observed, compared to acute shunt dysfunctions. The less invasive procedure and shorter hospital stay are at the expense of more stent reinterventions.