Division of Cardiovascular Surgery, Geneva University Hospitals, Geneva, Switzerland.
J Thorac Cardiovasc Surg. 2010 Oct;140(4):836-44. doi: 10.1016/j.jtcvs.2010.06.036. Epub 2010 Jul 24.
Aortic valve repair has encouraging midterm results in selected patients. However, neither the long-term results of cusp extension nor the durability of different pericardial fixation techniques has been reported. Our goal was to address these issues.
Seventy-eight children with severe rheumatic aortic regurgitation (mean age 12 ± 3.5 years) underwent aortic valve repair using cusp extension over a 15-year period, with fresh autologous pericardium in 53 (67.9%), glutaraldehyde-fixed bovine pericardium in 9 (11.5%), and PhotoFix bovine pericardium (Sorin CarboMedics, Milano, Italy) in 16 (20.5%). Fifty-seven children (73.1%) underwent concomitant mitral valve repair, and 8 children (10.3%) underwent tricuspid valve repair.
There was 1 operative death from left ventricular failure. During a median follow-up of 10.7 years (range 1 month to 16.4 years), 1 late death occurred and 15 patients (19.7%) required reoperation at a mean of 43 ± 33.7 months (range 1 month to 9 years), 9 within the autologous pericardium group (18%), 3 within the bovine pericardium group (33%), and 3 within the PhotoFix pericardium group (19%). Freedom from reoperation was 96% ± 2.3% at 1 year, 87.5% ± 3.9% at 5 years, 80.7% ± 4.9% at 10 years, and 75.3% ± 6% at 15 years, and was significantly decreased in the bovine pericardium group (P = .039). On multivariable analysis, greater age (hazard ratio 1.25, P < .001) and acute rheumatic carditis (hazard ratio 8.15, P = .001) at operation were significant predictors of reoperation.
Aortic cusp extension provides adequate valve repair in a large proportion of children with rheumatic aortic regurgitation. Fresh autologous and PhotoFix pericardium trended toward better durability than glutaraldehyde-fixed bovine pericardium.
在选定的患者中，主动脉瓣修复具有令人鼓舞的中期结果。然而，尚未报道瓣叶延长的长期结果以及不同的心包膜固定技术的耐久性。我们的目标是解决这些问题。
在 15 年的时间里，78 例患有严重风湿性主动脉瓣反流的儿童（平均年龄 12 ± 3.5 岁）接受了主动脉瓣瓣叶延长修复术，其中 53 例（67.9％）使用新鲜的同种异体心包，9 例（11.5％）使用戊二醛固定的牛心包，16 例（20.5％）使用 PhotoFix 牛心包（Sorin CarboMedics，米兰，意大利）。57 例（73.1％）患儿同时行二尖瓣修复术，8 例（10.3％）患儿行三尖瓣修复术。
1 例死于左心衰竭。中位随访时间为 10.7 年（1 个月至 16.4 年），1 例患儿死亡，15 例（19.7％）患儿在平均 43 ± 33.7 个月（1 个月至 9 年）时需要再次手术，其中 9 例来自同种异体心包组（18％），3 例来自牛心包组（33％），3 例来自 PhotoFix 心包组（19％）。1 年时无再手术率为 96％±2.3％，5 年时为 87.5％±3.9％，10 年时为 80.7％±4.9％，15 年时为 75.3％±6％，牛心包组明显降低（P =.039）。多变量分析显示，手术时年龄较大（危险比 1.25，P <.001）和急性风湿性心内膜炎（危险比 8.15，P =.001）是再手术的显著预测因素。
在大多数患有风湿性主动脉瓣反流的儿童中，主动脉瓣叶延长术可提供足够的瓣膜修复。新鲜同种异体和 PhotoFix 心包的耐久性趋势优于戊二醛固定的牛心包。
