KS Lun, CSW Chiu, TC Yung, YF Cheung, LC Cheng, AKT Chau

Abstract

Objective: We evaluate our intermediate-term results of our patients who had insertion of homografts for repair of their congenital heart diseases since the first application in April 1999. Background: Use of homograft valve in the repair of complex congenital heart lesions has been a standard for over two decades. However, homograft is not available locally because of lack of donor. Since 1999, we were able to obtain limited supply of homograft from England. Methods: Between 26 April 1999 and 28 February 2005, 45 patients had insertion of homografts for repair of congenital heart disease. The mean age of operation was 7.2±6.2 years (33 days-28 years). The mean follow-up duration was 32.5±20.6 months (0.03-71 months). The follow-up clinical status was reviewed. Overall survival and freedom from reoperation due to conduit failure were estimated by Kaplan-Meier method. Homograft valve stenosis or regurgitation was assessed by serial echocardiography and cardiac catheterisation. Results: There were one early death (2.2%) and two late deaths (4.4%). One of the late deaths died from non-cardiac cause due to severe bronchial stenosis. The actuarial survival was 93% at 71 months. Of the 42 survivors, majority had improved functional status significantly. There were 40 patients (95%) in NYHA class I or II. Three patients (6.7%) required reoperation for conduit failure. The freedom from reoperation was 85% at 71 months. One patient is awaiting reoperation for severe pulmonary homograft and aortic (truncal) regurgitation. Homograft conduit function of the remaining patients was satisfactory on follow-up. Conclusion: This study showed satisfactory intermediate-term outcome in patients after cardiac operations using homograft.

目的：我們評價自 1999 年 4 月以來為修補先天性心臟病而置入同種外管道病人的中期效果。背景：在複雜性先天性心臟缺損的修補中，同種外管道的應用成為一種標準已經有二十年的歷史。然而，由於供應缺乏，在當地同種外管道不能得到。自 1999 年以來，我們能夠獲得來自英國的限量同種外管道。方法：在 1999 年 4 月 26 日至 2005 年 2 月 28 日期間，為了修補先天性心臟病，已經有 45 個病人置入同種外管道。手術平均年齡 7.2±6.2 年（33 天至 28 歲）。平均隨訪期為 32.5±20.6 月（0.03 至 71 月）。回顧隨訪的臨床狀況。用 Kaplan-Meier 方法來評價總的存活以及免於因管道故障而再手術。通過系列超聲心動圖和心導管來評價同種帶瓣外管道狹窄或返流。結果：早期死亡一例。晚期死亡二例。晚期死亡的其中一個的原因為嚴重支氣管狹窄而非因心臟出現問題。 71 個月中，精確的存活率為 93%。42 個存活者中，大多數病人的身體狀況得到明顯改善。有 40 個病人（95%）處於 NYHA I 級或 II 級。3 個病人由於管道故障而再手術。71 個月中，免於再手術率為 85%。隨訪中，大多數病人的同種外管道功能屬滿意。結論：這個研究顯示應用同種外管道心臟手術後的病人具有良好的中期效果。