A comparative study of three palliative surgical approaches for pulmonary atresia with ventricular septal defect
- VernacularTitle:三种姑息手术方法治疗肺动脉闭锁伴室间隔缺损的对比研究
- Author:
Zhiying SONG
1
,
2
;
Jinghao ZHENG
1
,
2
;
Xiaomin HE
1
,
2
;
Kai LUO
1
,
2
;
Qi SUN
1
,
2
;
Huiwen CHEN
1
,
2
;
Zhongqun ZHU
1
,
2
;
Hao ZHANG
1
,
2
;
Zhiwei XU
1
,
2
;
Jinfen LIU
1
,
2
Author Information
1. Department of Cardiothoracic Surgery, Shanghai Children&rsquo
2. s Medical Center, Shanghai Jiao Tong University School of Medicine, Shanghai, 200127, P. R. China
- Publication Type:Journal Article
- Keywords:
Pulmonary atresia with ventricular septal defect;
systemic-pulmonary shunt;
right ventricle-pulmonary artery connection
- From:
Chinese Journal of Clinical Thoracic and Cardiovascular Surgery
2023;30(02):266-272
- CountryChina
- Language:Chinese
-
Abstract:
Objective To compare and investigate the efficacy and differences of modified B-T shunt, central shunt and right ventricle-pulmonary artery (RV-PA) connection in the treatment of pulmonary atresia with ventricular septal defect (PA/VSD). Methods A total of 124 children with PA/VSD underwent initial palliative repair in Shanghai Children's Medical Center from September 2014 to August 2019, including 63 males and 61 females, aged 7 days to 15 years. They were divided into in a modified B-T shunt group (55 patients), a central shunt group (22 patients) and a RV-PA connection group (47 patients). The clinical data of these children were retrospectively analyzed. Results There were 9 early deaths after palliation, with an early mortality rate of 7.3%. The mean follow-up time was 26.5±20.3 months, with 5 patients lost to follow-up, 5 deaths during the follow-up period, and 105 survivors. The 1-year and 5-year survival rates were both 89.7%. The monthly increased Nakata index was 5.2 (–0.2, 12.3) mm2/m2, 9.2 (0.1, 23.6) mm2/m2, 6.3 (1.8, 23.3) mm2/m2 in the modified B-T shunt group, the central shunt group, and the RV-PA connection group, respectively, with no statistical difference among the three groups. The 1-year survival rate was 85.3%, 78.4%, 95.2%, and the 5-year (4-year in the central shunt group) survival rate was 85.3%, 58.8%, 95.2% in the three groups, respectively, with a statistical difference among them (P<0.05). The complete repair rate was 36.5%, 19.0% and 67.4% in the three groups, respectively, with a statistical difference among the three groups (P<0.001). Conclusion All these three palliative surgical approaches can effectively promote pulmonary vascular development. But compared with systemic-pulmonary shunt, RV-PA connection has a lower perioperative mortality rate and can achieve a higher complete repair rate at a later stage, which is beneficial for long-term prognosis.
