초록접수 현황
| 16F-108 | 구연 발표 |
Right Ventricle to Pulmonary Artery Connection with a Cryopreserved Femoral Vein Homograft as a Valved Conduit in Neonates and Small Infants
Heemoon Lee, MD, Ji-Hyuk Yang, MD, PhD, Tae-Gook Jun, MD, PhD, Yang Hyun Cho, MD, PhD, Pyo Won Park, MD, PhD
Department of Thoracic and Cardiovascular Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
Background : Lack of small-sized homografts is a major obstacle to reconstruct the right ventricular outflow tract in early infancy. The aim of this study is to assess the clinical outcome of a cryopreserved femoral vein homograft (cFVH) as a valved conduit in the pulmonary position.
Methods : From 2007 to 2015, 25 patients underwent placement of cFVH for right ventricle-pulmonary artery (RV-PA) connection. Their median age at surgery was 2.0months (range, 4 days~8.2 months). Median body weight was 3.4 kg (range, 2.3~8). Eighteen patients underwent biventricular repair; 13 Rastelli-type operation for pulmonary atresia (PA)/ventricular septal defect (VSD) with major aortopulmonary collaterals (MAPCA) (n=3), without collaterals (n=5), or truncus arteriosus (n=5); 5 Norwood-Rastelli operation for aortic atresia (n=3) or interrupted aortic arch (n=2). Seven patients underwent palliative RV-PA connection for PA/VSD with MAPCA (n=5), and without collaterals (n=2). CATCH 22 was combined in 8 patients (32%). The median diameter of the homograft was 10 mm (range, 7~12).
Results : There was 1 in-hospital death (4.0%) in the patient who underwent palliative RV-PA connection and MACPA unifocalization. Median follow-up period was 53.0 months (range, 0.3~94.1). Graft dysfunction was observed in 17 patients. Freedom from graft dysfunction was 95.0% at 6 months and 57.8% at 12 months, respectively. Freedom from explantation for graft dysfunction was 95.7% at 6 months and 63.9% at 12 months, respectively. Among 6 survivors of palliation group, 5 underwent a total correction at the next operation.
Conclusion : Although the population of this study is small, cFVH can be used safely for RV-PA connection in neonates or small infants. The graft may facilitate earlier total correction without additional palliative procedures. However, the durability seems to be limited mainly because of its small size.
Methods : From 2007 to 2015, 25 patients underwent placement of cFVH for right ventricle-pulmonary artery (RV-PA) connection. Their median age at surgery was 2.0months (range, 4 days~8.2 months). Median body weight was 3.4 kg (range, 2.3~8). Eighteen patients underwent biventricular repair; 13 Rastelli-type operation for pulmonary atresia (PA)/ventricular septal defect (VSD) with major aortopulmonary collaterals (MAPCA) (n=3), without collaterals (n=5), or truncus arteriosus (n=5); 5 Norwood-Rastelli operation for aortic atresia (n=3) or interrupted aortic arch (n=2). Seven patients underwent palliative RV-PA connection for PA/VSD with MAPCA (n=5), and without collaterals (n=2). CATCH 22 was combined in 8 patients (32%). The median diameter of the homograft was 10 mm (range, 7~12).
Results : There was 1 in-hospital death (4.0%) in the patient who underwent palliative RV-PA connection and MACPA unifocalization. Median follow-up period was 53.0 months (range, 0.3~94.1). Graft dysfunction was observed in 17 patients. Freedom from graft dysfunction was 95.0% at 6 months and 57.8% at 12 months, respectively. Freedom from explantation for graft dysfunction was 95.7% at 6 months and 63.9% at 12 months, respectively. Among 6 survivors of palliation group, 5 underwent a total correction at the next operation.
Conclusion : Although the population of this study is small, cFVH can be used safely for RV-PA connection in neonates or small infants. The graft may facilitate earlier total correction without additional palliative procedures. However, the durability seems to be limited mainly because of its small size.
책임저자: Ji-Hyuk Yang
Department of Thoracic and Cardiovascular Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
발표자: Heemoon Lee, E-mail : rhythmists@gmail.com