One-Stage Unifocalization and Palliative Right Ventricular Outflow Tract Reconstruction

Shinkawa, Takeshi; Yamagishi, Masaaki; Shuntoh, Keisuke; Takahashi, Akiyuki; Hayashida, Kentaro; Kitamura, Nobuo

doi:10.1016/j.athoracsur.2003.09.109

Cited by 7 publications

(6 citation statements)

References 6 publications

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“…We managed to achieve an adequate pulmonary blood flow with the palliative right ventricular outflow tract reconstruction in several patients by making the diameter of the right ventricular outflow tract 70% of that of the normal pulmonary annulus. 12 Our experience has found that postoperative hypoxemia is an important complication of this surgery. However, the reason for this is not understood.…”

Section: Discussionmentioning

confidence: 96%

Dexmedetomidine Attenuates Hypoxemia During Palliative Reconstruction of the Right Ventricular Outflow Tract in Pediatric Patients

Chen¹,

Zhang³

et al. 2014

Medicine

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The objective of this study was to investigate whether the α agonist dexmedetomidine has the ability to attenuate hypoxemia in pediatric patients undergoing palliative pulmonary artery reconstruction.From January 2009 to January 2013, a total of 25 pediatric patients with Tetralogy of Fallot, pulmonary atresia (ventricular septal defect), or persistent truncus arteriosus (I) were enrolled in our study. Due to hypoplastic pulmonary arteries, all patients received palliative pulmonary artery reconstruction. During the perioperative period, they were allocated to receive either dexmedetomidine (bolus dose of 0.3 μg/kg followed by an infusion of 0.2–0.3 μg/kg/h, n = 15) or control drug (n = 10) intravenously. Any desaturation was recorded. Heart rate, mean arterial pressure, pulse oximetry, and arterial blood gas parameters were measured during the perioperative period.There were no significant differences between the groups in hemodynamic variables. The arterial oxygen saturation and arterial blood gas parameters increased in the dexmedetomidine groups (P < 0.05).These findings suggest that the injection of dexmedetomidine can attenuate hypoxemia during palliative pulmonary artery reconstruction in pediatric patients.

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Section: Discussionmentioning

confidence: 96%

Dexmedetomidine Attenuates Hypoxemia During Palliative Reconstruction of the Right Ventricular Outflow Tract in Pediatric Patients

Chen¹,

Zhang³

et al. 2014

Medicine

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“…We performed side‐to‐side or end‐to‐side anastomosis with MAPCAs for UF and the central Pas were enlarged with fresh autologous pericardium from hilum to hilum. In cases of the absence of a central Pa or had not enough diameter for augmentation, we used a roll of the pericardium to create central Pa as described by the Shinkawa et al 10 We wrap the pericardium around a 10 mm diameter bougie and suture its edge with 7‐0 sutures to form a tube graft. Right and left MAPCAs were unifocalized by side‐to‐side or end‐to‐side anastomosis and the rolled tube graft was anastomosed to each unifocalized side by end‐to‐end anastomosis.…”

Section: Methodsmentioning

confidence: 99%

“…Generally, we use direct native tissue-to-tissue anastomosis with autologous pericardium for UF and the fresh autologous pericardium is a very useful material but it is difficult to maintain its shape. 10 On the other hand, creating a pericardial roll and placing it behind the aorta has a risk of compression by the aorta. 10 Pericardial roll stenosis due to aortic compression did not develop in our study.…”

Section: Postoperative Outcomesmentioning

confidence: 99%

“…As a surgical technique, midline UF is commonly performed by side‐to‐side anastomosis of MAPCAs to the Pa and augmentation of central Pas with a patch 9 . However, some case reports have reported the use of a pericardial roll to create central Pa and connect the right and left‐sided unifocalized pulmonary arteries 10 . Although we used the central Pa patch technique after side to side anastomosis of MAPCAs at first, recently started to use the pericardial roll in the midline UF in selected cases.…”

Section: Introductionmentioning

confidence: 99%

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Unifocalization with pericardial roll technique in pulmonary atresia with ventricular septal defect and major aortopulmonary collateral arteries

Önalan

Çiçek

Rum

et al. 2022

Journal of Cardiac Surgery

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Objective This study aims to compare both the pericardial roll technique with the patch augmentation technique of the unifocalization, and single‐stage complete repair with the unifocalization and shunt for the repair of the ventricular septal defect, pulmonary atresia, and major aortopulmonary collateral arteries. Methods This was a retrospective review of the 48 patients undergoing unifocalization of the ventricular septal defect, pulmonary atresia, and major aorticopulmonary collateral arteries from a single center. Our cohort had two surgical pathways, including single‐stage midline unifocalization (n = 40), unifocalization after pulmonary artery rehabilitation by creating an aortopulmonary window or central shunt (n = 8). There were two surgical techniques in single‐stage midline unifocalizaton, including widening of the pulmonary arteries with a patch (n = 30), and connecting pulmonary arteries with a pericardial roll (n = 10). Results A total of 14 (29.2%) of 48 patients underwent single‐stage complete repair, 26 patients underwent shunt palliation with unifocalization. Combined early and late mortality was seen in seven patients in those who underwent shunt palliation with unifocalization, while it was seen in one patient in those who underwent a single‐stage complete repair (mortality ratio 26.8% vs. 7.1%, p = .22). There was no statistically significant difference between the pericardial roll and patch augmentation techniques in terms of pulmonary artery reintervention (p = .65). Although all pulmonary artery reinterventions were for unilateral pulmonary artery in the roll technique group, 41.7% of reinterventions were for bilateral pulmonary arteries in the pericardial augmentation group. Conclusion Single‐stage complete repair of the ventricular septal defect, pulmonary atresia, and major aorticopulmonary collateral arteries has better results than unifocalization with a shunt. In terms of nonvaluable raw material, the use of the pericardial roll technique is a considerable alternative for unifocalization.

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“…Informed consent was obtained from the patient's family. According to our surgical strategy for PA/VSD/MAPCAs [7], the firststage palliative operation was done and included unifocalization of all MAPCAs, creation of the central PA with autologous pericardial tubes, and palliative right ventricular outflow tract (RVOT) reconstruction by an expanded polytetrafluoroethylene (ePTFE) conduit bearing a fan-shaped ePTFE valve [8] through a median sternotomy. The VSD was left open.…”

Section: Clinical Experiencementioning

confidence: 99%

First Successful Clinical Application of the In Vivo Tissue-Engineered Autologous Vascular Graft

Kato

Yamagishi

Kanda

et al. 2016

The Annals of Thoracic Surgery

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One-Stage Unifocalization and Palliative Right Ventricular Outflow Tract Reconstruction

Cited by 7 publications

References 6 publications

Dexmedetomidine Attenuates Hypoxemia During Palliative Reconstruction of the Right Ventricular Outflow Tract in Pediatric Patients

Dexmedetomidine Attenuates Hypoxemia During Palliative Reconstruction of the Right Ventricular Outflow Tract in Pediatric Patients

Unifocalization with pericardial roll technique in pulmonary atresia with ventricular septal defect and major aortopulmonary collateral arteries

First Successful Clinical Application of the In Vivo Tissue-Engineered Autologous Vascular Graft

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