Hetzer Roland, Delmo Walter Eva B Maria, Hübler Michael, Alexi-Meskishvili Vladimir, Weng Yuguo, Nagdyman Nicole, Berger Felix
Department of Cardiovascular and Thoracic Surgery, Deutsches Herzzentrum Berlin, Berlin, Germany.
Ann Thorac Surg. 2008 Aug;86(2):604-13. doi: 10.1016/j.athoracsur.2008.03.026.
This study evaluates early and long-term outcome and freedom from reoperation after mitral valve (MV) reconstruction in children using various standard and modified reconstruction techniques.
Between June 1987 and December 2006, 111 children (mean age, 7.5 +/- 5.9 years) with congenital and acquired MV diseases underwent MV reconstruction. Six children were aged younger than 3 months old, 28 were 3 months to 2 years, and 77 were 2 to 18 years old. Congenital MV lesions were found in 84.6%, isolated MV disease was found in 54.1%, and MV insufficiency was the predominant pathophysiology in 80%. Various standard repair techniques and our own modifications were used according to the lesions.
Early mortality was 4.5%, and late mortality was 7.3%. Actuarial survival at 10 years was 77.4%. Actuarial reoperation-free survival at 10 and 15 years was 79.2%. At 19 years, freedom from MV replacement was 81.8% +/- 7.5%, and freedom from repeat reconstruction 91% +/- 1.5%. Mean follow-up was 5.4 years. Age younger than 3 months, urgency of operation, concomitant procedures, and coexisting anomalies were strong predictors of poor overall freedom from reoperation and decreased early and late survival. The highly satisfactory results were achieved by careful structural and functional assessment of the valve, avoidance of prosthetic material, and use of a spectrum of repair techniques tailored to the individual case that address all components of the valve lesion.
Mitral valve reconstruction in children using various surgical techniques provides satisfactory early and long-term survival and clinical outcome with low reoperation rates.
本研究评估了采用各种标准和改良重建技术对儿童二尖瓣（MV）进行重建后的早期和长期结果以及再次手术的自由度。
1987年6月至2006年12月期间，111例患有先天性和后天性MV疾病的儿童（平均年龄7.5±5.9岁）接受了MV重建。6例患儿年龄小于3个月，28例为3个月至2岁，77例为2至18岁。84.6%发现有先天性MV病变，54.1%为孤立性MV疾病，80%以MV关闭不全为主要病理生理表现。根据病变情况采用了各种标准修复技术及我们自己的改良方法。
早期死亡率为4.5%，晚期死亡率为7.3%。10年时的精算生存率为77.4%。10年和15年时无再次手术的精算生存率为79.2%。19年时，无需进行MV置换的比例为81.8%±7.5%，无需再次重建的比例为91%±1.5%。平均随访时间为5.4年。年龄小于3个月、手术紧迫性、同期手术以及并存异常是再次手术总体自由度低以及早、晚期生存率降低的有力预测因素。通过对瓣膜进行仔细的结构和功能评估、避免使用人工材料以及针对个体病例采用一系列修复技术以解决瓣膜病变的所有组成部分，获得了高度满意的结果。
采用各种手术技术对儿童进行二尖瓣重建可提供令人满意的早期和长期生存率及临床结果，且再次手术率较低。
