端侧吻合与人工血管矫治婴儿主动脉弓离断早、中期疗效比较

Comparison of early and mid-term outcomes between end-to-side anastomosis and synthetic interposition graft in repairing infants with interrupted aortic arch

目的比较端侧吻合与人工血管方法矫治婴儿主动脉弓离断术后早、中期疗效。方法婴儿主动脉弓离断矫治手术26例,按手术方式分为端侧吻合组(16例)和人工血管组(10例),随访6~84个月。比较两组患儿术后早、中期的主要疗效。结果人工血管组与端侧吻合组早期疗效比较,差异无统计学意义(P>0.05),其中转流时间分别为(119.3±21.5)分钟和(148.4±56.6)分钟,主动脉阻断时间分别为(65.0±30.1)分钟和(79.4±29.1)分钟,停循环时间分别为(24.3±6.4)分钟和(23.3±13.4)分钟,呼吸机辅助时间分别为(113.1±36.9)小时和(124.3±48.1)小时,重症监护室时间分别为(12.9±6.3)天和(13.0±3.6)天,早期死亡分别为0例和2例,术后早期相关并发症分别为2例和6例。中期疗效比较,差异无统计学意义(P>0.05),其中中期死亡分别为0例和1例,左室流出道梗阻分别为3例和2例,主动脉弓再狭窄分别为3例和1例(重度狭窄),心功能(NYHA)Ⅰ~Ⅱ级分别为10例和9例。结论使用人工血管治疗主动脉弓离断是一种可行的替代方案,特别是对于主动脉弓离断较远时,远期需要进一步干预处理。

Objective To compare early and mid-term outcomes between end-to-side anastomosis and synthetic interposition graft in repairing infant interrupted aortic arch（IAA）.Methods 26 infants underwent a one-stage IAA repair.According to the operation points,26 infants were divided into two groups.10 of them had a synthetic interposition graft while the other 16 patients（two of them used bovine pericardium to broaden the antetheca of aortic arch） had end-to-side anastomosis to reconstruct the aortic arch.Follow-up time range from 6 to 84 months.Then compared early and mid-term outcomes.Results Comparison the early outcomes（group of a synthetic interposition graft vs group of end-to-side anastomosis）：cardiopulmonary bypass time（119.3±21.5）min vs（148.4±56.6）min,aortic clamping time（65.0±30.1）min vs（79.4±29.1）min,circulatory arrest time（24.3±6.4）min vs（23.3±13.4）min,ventilating time（113.1±36.9）h vs（124.3±48.1）h,intensive care unit （ICU）stay time（12.9±6.3）d vs（13.0±3.6）d,mortality（0 case vs 2 cases）,postoperative complications（2 cases vs 6 cases）.Postoperative mid-term results：mortality（0 case vs 1 cases）,left ventricular outflow track obstruction（LVOTO）（3 cases vs 2 cases）,The aortic arch restenosis（3 cases vs 1 cases）,New York Heart Association （NYHA） Ⅰ~Ⅱ（10 cases vs 9 cases）.There were no significant differences in all early and mid-term outcomes between a synthetic interposition graft and end-to-side anastomosis to repair IAA（P〉0.05）.Using a synthetic interposition graft and end-to-side anastomosis are both effective methods to repair IAA,there were no significant differences in all early and mid-term outcomes between these two methods.Conclusion It＇s a feasible alternative to use a synthetic interposition graft to repair IAA,especially for the cases when IAA merged with the long isthmus,and further intervention were needed for the long-term curative effect.