Department of Cardiac Surgery, Royal Children's Hospital, and Department of Pediatrics, University of Melbourne, Melbourne, Australia.
Ann Thorac Surg. 2012 Aug;94(2):606-13; discussion 613. doi: 10.1016/j.athoracsur.2012.03.058. Epub 2012 May 16.
Outcomes after atrioventricular (AV) valve operations in patients with functional single ventricles are unclear.
From 1988 to 2010, 76 consecutive patients with single ventricles underwent AV valve operations for regurgitation at a single institution. Five replacements, 66 repairs, and 5 valve closures were performed at a median age of 1 year (range, 1 day-14 years) on 43 tricuspid, 9 mitral, and 24 common AV valves.
Hospital mortality was 17% (13/76). The follow-up was 100% complete. There were 15 late deaths. There were 48 survivors with a mean follow-up of 8.3±6 years. One- and 10-year Kaplan-Meier survival after AV valve operations was 72% (95% confidence interval [CI], 60%-81%) and 61% (95% CI, 48%-71%), respectively. Independent predictors of overall mortality were presence of a common AV valve (p=0.03), requirement for postoperative mechanical circulatory support (p=0.02), and timing of valve operations between initial palliation and performance of a bidirectional cavopulmonary shunt (BCPS) (p=0.047). Ten-year freedom from valve reoperation and from thromboembolic events of hospital survivors was 56% (95% CI, 38%-70%) and 70% (95% CI, 56%-80%), respectively. At last follow-up, 11 of 48 surviving patients (23%) had moderate to severe regurgitation, and pacemaker implantation was required in 6 patients. Only 34 patients reached the stage of Fontan completion.
AV valve regurgitation is a considerable burden for the patient with a single ventricle, especially when appearing at a young age. A quarter of patients died within the first year after operation, and they had considerable morbidity in terms of reoperation, thromboembolic events, and pacemaker implantation. Their chances of reaching Fontan completion seemed decreased.
功能性单心室患者房室（AV）瓣手术后的结果尚不清楚。
1988 年至 2010 年，在一家机构中，76 例单心室患者因反流接受了 AV 瓣手术。在中位年龄为 1 岁（范围为 1 天至 14 岁）时，对 43 个三尖瓣、9 个二尖瓣和 24 个共同 AV 瓣进行了 5 次置换、66 次修复和 5 次瓣环闭合。
院内死亡率为 17%（13/76）。随访率为 100%。有 15 例晚期死亡。48 例幸存者的平均随访时间为 8.3±6 年。AV 瓣手术后的 1 年和 10 年 Kaplan-Meier 生存率分别为 72%（95%置信区间[CI]，60%-81%）和 61%（95%CI，48%-71%）。总死亡率的独立预测因素包括存在共同 AV 瓣（p=0.03）、术后需要机械循环支持（p=0.02）以及 AV 瓣手术时机（初始姑息治疗与双向腔肺分流术[BCPS]之间）（p=0.047）。存活者的 10 年免于瓣膜再手术和免于血栓栓塞事件的概率分别为 56%（95%CI，38%-70%）和 70%（95%CI，56%-80%）。最后一次随访时，48 例存活患者中有 11 例（23%）存在中度至重度反流，6 例患者需要植入起搏器。只有 34 例患者达到了 Fontan 完成阶段。
AV 瓣反流是单心室患者的一个相当大的负担，尤其是在年轻时出现反流时。四分之一的患者在手术后 1 年内死亡，他们在再手术、血栓栓塞事件和起搏器植入方面存在相当大的发病率。他们达到 Fontan 完成阶段的机会似乎减少了。
