主动脉-肺动脉和静脉-静脉侧支对丰坦手术后发生塑性支气管炎的影响。

IF 4.9 1区医学 Q1 CARDIAC & CARDIOVASCULAR SYSTEMS

Journal of Thoracic and Cardiovascular Surgery Pub Date : 2024-10-09 DOI:10.1016/j.jtcvs.2024.09.049

Takuya Osawa MD , Thibault Schaeffer MD , Mervin Schmiel MS , Michelle Bao Hoa Nguyen Cong MS , Carolin Niedermaier MS , Paul Philipp Heinisch MD, PhD , Nicole Piber MD , Stanimir Georgiev MD, PhD , Alfred Hager MD, PhD , Peter Ewert MD, PhD , Jürgen Hörer MD, PhD , Masamichi Ono MD, PhD

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引用次数: 0

摘要

研究目的本研究旨在明确丰坦手术后塑性支气管炎患者的主动脉-肺动脉/静脉袢的相关性：方法：对 1994 年至 2022 年期间接受全腔肺连接的所有患者进行回顾性研究。通过血管造影检测主动脉-肺动脉/静脉袢。评估了主动脉-肺动脉/静脉瓣对塑性支气管炎发病的影响以及其他变量：结果：共纳入 635 名患者。结果：共纳入 635 例患者，其中 15 例（2.4%）患者出现塑性支气管炎，从全腔肺连接到出现塑性支气管炎的中位时间为 1.1 年。5年和10年后不再患塑性支气管炎的比例分别为97.5%和96.5%。至于 PB 与 APCs/VVCs 的关系，PB 患者 TCPC 后 APCs 的发生率增加（60 对 14%，p 结论：方坦后主动脉-肺动脉和静脉-静脉袢的发生与塑性支气管炎的发生显著相关。治疗或缓解袢可能是防止发生塑性支气管炎的一个机会，而塑性支气管炎是方坦术后发病率和死亡率过高的一个原因。

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Impact of aortopulmonary and venovenous collaterals on the onset of plastic bronchitis after the Fontan procedure

Objective

To clarify the association of the aortopulmonary collaterals (APCs)/venovenous collateral (VVCs) in patients with plastic bronchitis (PB) after the Fontan procedure.

Methods

All patients who underwent total cavopulmonary connection from 1994 to 2022 were reviewed. APCs/VVCs were detected using angiography. The impact of APC/VVCs, as well as other variables on the onset of plastic bronchitis, was evaluated.

Results

A total of 635 patients were included. Plastic bronchitis was observed in 15 (2.4%) patients, and the median duration between total cavopulmonary connection and the onset of plastic bronchitis was 1.1 years. Freedom from PB at 5 and 10 years was 97.5% and 96.5%, respectively. As for the association of PB and APCs/VVCs, patients with PB had an increased incidence of post-total cavopulmonary connection APCs (60% vs 14%, P < .001) and VVCs (53% vs 14%, P < .001). Freedom from PB was the lowest in the patients who were associated with both APCs and VVCs after total cavopulmonary connection. APCs after total cavopulmonary connection (P = .002; hazard ratio, 5.729), VVCs after total cavopulmonary connection (P = .016; hazard ratio, 3.527), and chylothorax (P = .019; hazard ratio, 3.662) were identified as independently associated factors with the onset of PB.

Conclusions

The occurrence of post-Fontan APCs and VVCs was significantly associated with the development of PB. Treatment or mitigation of collaterals may represent an opportunity to prevent the development of PB, a remaining source of post-Fontan excess morbidity and mortality.

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来源期刊

Journal of Thoracic and Cardiovascular Surgery 医学-呼吸系统

CiteScore

11.20

自引率

10.00%

发文量

1079

审稿时长

68 days

期刊介绍： The Journal of Thoracic and Cardiovascular Surgery presents original, peer-reviewed articles on diseases of the heart, great vessels, lungs and thorax with emphasis on surgical interventions. An official publication of The American Association for Thoracic Surgery and The Western Thoracic Surgical Association, the Journal focuses on techniques and developments in acquired cardiac surgery, congenital cardiac repair, thoracic procedures, heart and lung transplantation, mechanical circulatory support and other procedures.