Lupinetti F M, Duncan B W, Scifres A M, Fearneyhough C T, Kilian K, Rosenthal G L, Cecchin F, Jones T K, Herndon S P
Department of Surgery, Children's Hospital and Regional Medical Center and the University of Washington, Seattle 98105, USA.
Ann Thorac Surg. 1999 Aug;68(2):521-5; discussion 525-6. doi: 10.1016/s0003-4975(99)00642-6.
Aortic valve replacement (AVR) in children is now more commonly performed with human tissue valves.
The results of 100 consecutive pediatric AVRs (50 mechanical, 50 human) were reviewed.
There were five perioperative deaths in the mechanical group and one in the human group (p = 0.2). Late complications in the mechanical group included 4 late deaths, 2 cases of endocarditis, 3 thromboembolic complications, and 10 reoperations on the aortic valve. In the human group, there were no late deaths, 2 reoperations for allograft aortic valve deterioration (both in Marfan's patients), and 1 reoperation for allograft pulmonary valve stenosis. Four-year actuarial survival was 83% in the mechanical group and 98% in the human group (p = 0.02). Four-year actuarial survival free of all valve-related complications was 61% in the mechanical group and 88% in the human group (p = 0.008).
Human valves in children requiring AVR provide superior intermediate-term survival and freedom from valve-related complications compared to mechanical valves. Marfan's syndrome may represent a rare remaining contraindication for human AVR in children.
目前儿童主动脉瓣置换术（AVR）更常使用生物组织瓣膜。
回顾了连续100例儿童AVR手术的结果（50例使用机械瓣膜，50例使用生物组织瓣膜）。
机械瓣膜组围手术期死亡5例，生物组织瓣膜组1例（p = 0.2）。机械瓣膜组的晚期并发症包括4例晚期死亡、2例心内膜炎、3例血栓栓塞并发症以及10例主动脉瓣再次手术。生物组织瓣膜组无晚期死亡，2例因同种异体主动脉瓣退变再次手术（均为马凡综合征患者），1例因同种异体肺动脉瓣狭窄再次手术。机械瓣膜组4年精算生存率为83%，生物组织瓣膜组为98%（p = 0.02）。机械瓣膜组4年无所有瓣膜相关并发症的精算生存率为61%，生物组织瓣膜组为88%（p = 0.008）。
与机械瓣膜相比，需要进行AVR的儿童使用生物组织瓣膜可提供更好的中期生存率且较少发生瓣膜相关并发症。马凡综合征可能是儿童使用生物组织瓣膜进行AVR的罕见的剩余禁忌证。
