유아기에서 우심실-폐동맥 간 도관을 이용한 양심실 교정의 결과

Abstract

Background : We investigated the outcomes of biventricular repair using a right ventricle to pulmonary artery (RV-PA) conduit placement in patients aged <1 year. Methods : Patients aged <1 year who underwent biventricular repair using an RV-PA conduit from 2011-2020 were enrolled in this study. The outcomes of interest were death from any cause, conduit reintervention, and conduit dysfunction (peak velocity of ≥3.5 m/sec or moderate or severe regurgitation). Results : Overall, 141 patients were enrolled. The median age at initial conduit implantation was 6 months. The median conduit diameter z-score was 1.3. The overall 5-year survival rate was 89.6%. The multivariable analysis revealed a younger age (p=0.006) and longer cardiopulmonary bypass time (p=0.001) as risk factors for overall mortality. During follow-ups, 61 patients required conduit reintervention, and conduit dysfunction occurred in 68 patients. The 5-year freedom from conduit reintervention and dysfunction rates were 52.9% and 45.9%, respectively. In the multivariable analysis, a smaller conduit z-score (p<0.001) emerged as a shared risk factor for conduit reintervention and dysfunction. Analysis of variance revealed a nonlinear relationship between the conduit z-score and conduit reintervention or dysfunction. The hazard ratio was lowest among patients with a conduit z-score of 1.3 for reintervention and 1.4 for dysfunction. Conclusion : RV-PA conduit placement can be safely performed in infants. A significant number of patients required conduit reintervention and had conduit dysfunction. Using a slightly over-sized conduit with a z-score of 1.3 may reduce the risk of conduit reintervention or dysfunction. Keywords : Right ventricle to pulmonary artery conduit, Infancy, Conduit reintervention, Conduit dysfunction, Conduit diameter z-score