초록접수 현황
| 19F-050 | 구연 미채택시 English competition forum 발표 |
Early Total Repair Versus Shunt Palliation in Ductal Dependent Neonates With Pulmonary Atresia and Ventricular Septal Defect : Results Of Two Hospitals
Eung Re Kim¹, Chang-Ha Lee¹, Jae Hong Lim¹, Yong Jin Kim¹, Woong-Han Kim²
¹Department of Thoracic and Cardiovascular Surgery, Sejong General Hospital, Gyeonggi-do, Republic of Korea, ²Department of Thoracic and Cardiovascular Surgery, Seoul National University Children’s Hospital, Seoul National University College of Medicine, Seoul, Republic of Korea
Purpose : The 2 surgical strategies of neonates with ductal-dependent pulmonary atresia and ventricular septal defect (PA VSD) include primary biventricular repair (BVR) or initial palliation with modified Blalock-Taussig shunt (BTS) followed by second stage repair. In this study, we report the combined outcomes of 2 hospitals with different strategies.
Methods : Between 2004 and 2017, 66 neonates underwent surgery using palliative shunt (BTS group: n=30, 45.5%) or early total repair (BVR group: n=36, 54.5%). Hospital A predominantly used BTS (80.6%, 29 out of 36) while hospital B almost always performed BVR (93%, 28 out of 30). Overall mean follow-up duration was 7.51 ± 4.35 years and early and late results were compared between the BTS group and BVR group.
Results : Mean age and body weight at the time of first operation were 18.05 ± 7.1 days and 3.23 ± 0.46 kg, respectively. Associated genetic and extra-cardiac anomalies were present in 15% of patients. Mean NAKATA index was 118.47 ± 41.52 with no difference between the two groups. There were 2 operative and 5 interstage mortalities in the BTS group but no deaths after second stage repair. The BVR group had 2 late deaths. Overall 10-year survival was 75.7% for BTS versus 94.4% for BVR (p=0.032).
Conclusion : Although primary BVR for neonates with ductal-dependent PA IVS provide better survival, the burden of RVOT intervention is heavy. The staged approach with BTS may improve the quality of biventricle repair, but the operative and interstage mortality has to be overcome.
Methods : Between 2004 and 2017, 66 neonates underwent surgery using palliative shunt (BTS group: n=30, 45.5%) or early total repair (BVR group: n=36, 54.5%). Hospital A predominantly used BTS (80.6%, 29 out of 36) while hospital B almost always performed BVR (93%, 28 out of 30). Overall mean follow-up duration was 7.51 ± 4.35 years and early and late results were compared between the BTS group and BVR group.
Results : Mean age and body weight at the time of first operation were 18.05 ± 7.1 days and 3.23 ± 0.46 kg, respectively. Associated genetic and extra-cardiac anomalies were present in 15% of patients. Mean NAKATA index was 118.47 ± 41.52 with no difference between the two groups. There were 2 operative and 5 interstage mortalities in the BTS group but no deaths after second stage repair. The BVR group had 2 late deaths. Overall 10-year survival was 75.7% for BTS versus 94.4% for BVR (p=0.032).
Conclusion : Although primary BVR for neonates with ductal-dependent PA IVS provide better survival, the burden of RVOT intervention is heavy. The staged approach with BTS may improve the quality of biventricle repair, but the operative and interstage mortality has to be overcome.
첨부파일 : 19F-050.pptx
책임저자: Eung Re Kim
Department of Thoracic and Cardiovascular Surgery, Sejong General Hospital, Gyeonggi-do, Republic of Korea
발표자: Eung Re Kim, E-mail : xion119@naver.com