The Annals of thoracic surgery · 2007
Damus-Rastelli procedure for biventricular repair of aortic atresia and hypoplasia.
СтатьяПоддержка исследования: вне правительства СШАНазвание и аннотация: Перевод в очереди
Обработка статьи · этапы, ошибки и управление
Загрузка состояния…
Ошибки и ограничения
История · было → стало
Состояние обновляется каждые 5 секунд, пока блок открыт. Процент показывается только там, где известен объём работы. Пауза останавливает продолжение этапа; текущий запрос к источнику может завершиться.
Moorthy Paneer S Krishna, McGuirk Simon P, Jones Timothy J, Brawn William J, Barron David J
Аннотация
BACKGROUND: Biventricular repair (BVR) can be achieved in aortic atresia with ventricular septal defect (VSD) by creating a double outlet left ventricle, Damus-Kaye-Stansel procedure and placement of a right ventricular-pulmonary artery conduit. This study is a review of 15 years experience with this "Damus-Rastelli" technique to assess clinical outcomes in comparison with a standard univentricular approach.
METHODS: A review of 16 patients with aortic atresia or complex left ventricular outflow tract obstruction who underwent BVR between 1990 and 2005; a comparison with outcomes for the Norwood I procedure over the same period.
RESULTS: Early mortality was 19% (3 patients) with no deaths in the last 12 years (13 patients). Twelve patients had associated aortic interruption (56%) or coarctation (19%). Anatomic subtype was not a risk for early death. Late age at operation was the only risk factor identified for early death (p = 0.01). Median follow-up was 32 (range, 4 to 190) months. Actuarial survival at one and five years was 60% and 53%, respectively. This compares with an early mortality of 29% (p < 0.01) and actuarial survival of 58% and 50% in the Norwood group. Freedom from reintervention was 68% and 20% at one and five years, respectively. One patient required balloon dilatation of recurrent coarctation, all others were balloon dilatation (n = 2) or surgical (n = 4) conduit replacement. All survivors are currently in New York Heart Association class I.
CONCLUSIONS: Biventricular repair of aortic atresia and VSD can be achieved with results that compare well with univentricular palliation. Despite the need for conduit change, the long-term benefit of a BVR would support this technique. Delay in performing the initial repair may increase mortality.
METHODS: A review of 16 patients with aortic atresia or complex left ventricular outflow tract obstruction who underwent BVR between 1990 and 2005; a comparison with outcomes for the Norwood I procedure over the same period.
RESULTS: Early mortality was 19% (3 patients) with no deaths in the last 12 years (13 patients). Twelve patients had associated aortic interruption (56%) or coarctation (19%). Anatomic subtype was not a risk for early death. Late age at operation was the only risk factor identified for early death (p = 0.01). Median follow-up was 32 (range, 4 to 190) months. Actuarial survival at one and five years was 60% and 53%, respectively. This compares with an early mortality of 29% (p < 0.01) and actuarial survival of 58% and 50% in the Norwood group. Freedom from reintervention was 68% and 20% at one and five years, respectively. One patient required balloon dilatation of recurrent coarctation, all others were balloon dilatation (n = 2) or surgical (n = 4) conduit replacement. All survivors are currently in New York Heart Association class I.
CONCLUSIONS: Biventricular repair of aortic atresia and VSD can be achieved with results that compare well with univentricular palliation. Despite the need for conduit change, the long-term benefit of a BVR would support this technique. Delay in performing the initial repair may increase mortality.