Gerosa G, McKay R, Ross D N
National Heart Hospital, London, England.
Ann Thorac Surg. 1991 Mar;51(3):424-9. doi: 10.1016/0003-4975(91)90858-n.
Between January 1967 and December 1988, 34 patients ranging in age from 3 to 18 years (mean, 14 +/- 3.6 years) underwent replacement of the aortic valve or root with their own pulmonary valve. The indication for operation was left ventricular outflow obstruction in 16 patients (47%), aortic regurgitation in 14 (41%), mixed aortic valve disease in 3 (9%), and failure of a previously implanted aortic homograft in 1 (3%). There were four early deaths, all before 1971, giving a hospital mortality of 11.8% (70% confidence interval, 6% to 20%). Surviving patients have been followed up a cumulative total of 214 patient-years, the longest period of observation being 16 years 8 months. Late mortality was 13.3% (70% confidence interval, 7% to 23%), and 4 other patients required removal of the pulmonary autograft for endocarditis. Actuarial rates at 16 years were 74% +/- 11% for freedom from reoperation on the left ventricular outflow tract, 80% +/- 10% for freedom from reoperation on the right ventricular outflow tract, and 77% +/- 10% for late survival. There was no instance of primary structural degeneration in the pulmonary autograft, and all surviving patients were in New York Heart Association functional class I without medication. This experience demonstrates that the pulmonary autograft can achieve good early and medium-term results in young patients. Should growth potential be realized, it might constitute the ideal biological valve for the left ventricular outflow in children.
1967年1月至1988年12月期间，34例年龄在3至18岁（平均14±3.6岁）的患者接受了自体肺动脉瓣置换主动脉瓣或主动脉根部手术。手术指征为左心室流出道梗阻16例（47%），主动脉瓣反流14例（41%），混合性主动脉瓣疾病3例（9%），以及1例（3%）先前植入的主动脉同种异体瓣膜功能衰竭。有4例早期死亡，均发生在1971年之前，医院死亡率为11.8%（70%置信区间，6%至20%）。存活患者累计随访214患者年，最长观察期为16年8个月。晚期死亡率为13.3%（70%置信区间，7%至23%），另有4例患者因心内膜炎需要取出自体肺动脉瓣。16年时左心室流出道无需再次手术的精算率为74%±11%，右心室流出道无需再次手术的精算率为80%±10%，晚期生存率为77%±10%。自体肺动脉瓣未出现原发性结构退变的情况，所有存活患者在未用药状态下均处于纽约心脏协会心功能I级。这一经验表明，自体肺动脉瓣在年轻患者中可取得良好的早期和中期效果。如果生长潜能得以实现，它可能成为儿童左心室流出道理想的生物瓣膜。
