Tiete A R, Sachweh J S, Groetzner J, Gulbins H, Muehler E G, Messmer B J, Daebritz S H
Department of Cardiac Surgery, University Hospital Grosshadern, Marchioninistr. 15, 81377, Munich, Germany.
Clin Res Cardiol. 2006 May;95(5):281-8. doi: 10.1007/s00392-006-0376-9.
We report the early and late outcome following left-sided mechanical heart valve replacement in children. Between 10/1981 and 02/2001, 27 children (13 male, mean age 7.2 +/- 5.2 years, range 0.53-15.7 years) underwent mechanical mitral (MVR 16), aortic (AVR 9) or double valve replacement (DVR 2) with St. Jude Medical valves. Eighteen children (66.7%) had undergone previous cardiac surgery. Valve disease was congenital in 23, due to endocarditis in 2 and rheumatic in 2 patients. Concomitant cardiac surgery was performed in 12 patients (44.4%). Operative mortality was 3.7% (1/27). Perioperative complications were complete heart block (5) and myocardial infarction (1). Mean follow-up was 6.5+/-5.9 years (range 0.4-19 years, total 169.9 patient-years). There was one valve-related late death due to mitral valve thrombosis without phenprocoumon. Actuarial survival after 1, 5 and 10 years was 93, 93 and 93%. Late complications included endocarditis (2), minor hemorrhagic event (1) and stroke (1). Overall 10-year freedom from any anticoagulation-related adverse event under phenprocoumon was 91% (1.3%/patient year). Eight patients required reoperations: re-MVR (5; outgrowth of the prostheses (3), pannus overgrowth (2)), closure of paravalvular leak after AVR (2), and re- DVR (1; endocarditis). Actuarial freedom from reoperation after 1, 5 and 10 years was 96, 88 and 76%.
Mechanical valve prostheses are a valuable option for left-sided heart valve replacement in pediatric patients with good results. Operative mortality and the incidence of any valve-related events as endocarditis, reoperation, thromboembolism or anticoagulation related bleeding is acceptable.
我们报告了儿童左侧机械心脏瓣膜置换术后的早期和晚期结果。在1981年10月至2001年2月期间，27名儿童（13名男性，平均年龄7.2±5.2岁，范围0.53 - 15.7岁）接受了使用圣犹达医疗瓣膜的二尖瓣置换术（MVR 16例）、主动脉瓣置换术（AVR 9例）或双瓣膜置换术（DVR 2例）。18名儿童（66.7%）曾接受过心脏手术。瓣膜疾病23例为先天性，2例因心内膜炎，2例因风湿性。12例患者（44.4%）同时进行了心脏手术。手术死亡率为3.7%（1/27）。围手术期并发症为完全性心脏传导阻滞（5例）和心肌梗死（1例）。平均随访时间为6.5±5.9年（范围0.4 - 19年，总计169.9患者年）。有1例因二尖瓣血栓形成且未使用苯丙香豆素导致与瓣膜相关的晚期死亡。1年、5年和10年的精算生存率分别为93%、93%和93%。晚期并发症包括心内膜炎（2例）、轻微出血事件（1例）和中风（1例）。在使用苯丙香豆素的情况下，总体10年无任何抗凝相关不良事件的概率为91%（1.3%/患者年）。8例患者需要再次手术：再次二尖瓣置换术（5例；假体增生（3例）、瓣周组织增生（2例）），主动脉瓣置换术后瓣周漏修补术（2例），再次双瓣膜置换术（1例；心内膜炎）。1年、5年和10年无再次手术的精算概率分别为96%、88%和76%。
机械瓣膜假体是小儿患者左侧心脏瓣膜置换的一种有价值的选择，效果良好。手术死亡率以及任何与瓣膜相关事件如心内膜炎、再次手术、血栓栓塞或抗凝相关出血的发生率是可以接受的。
