儿童生物替代物主动脉瓣置换术

Aortic valve replacement with biological substitutes in children.

作者信息

Talwar Sachin, Malankar Dhananjay, Garg Sanket, Choudhary Shiv Kumar, Saxena Anita, Velayoudham Devagourou, Kumar Arkalgud Sampath

机构信息

Cardiothoracic Centre, All India Institute of Medical Sciences, New Delhi, India.

出版信息

Asian Cardiovasc Thorac Ann. 2012 Oct;20(5):518-24. doi: 10.1177/0218492312439400.

DOI:10.1177/0218492312439400

PMID:23087293

Abstract

BACKGROUND

this study was performed to assess the results of aortic valve replacement in children with biological substitutes including homografts, pulmonary autografts (Ross procedure), and aortic valve reconstruction with autologous pericardium (Duran technique).

METHODS

between March 1992 and July 2009, 73 children with aortic valve disease (mean age, 11.8 ±2.7 years) underwent aortic valve replacement with biological substitutes including homografts, pulmonary autografts, and aortic valve reconstruction with autologous pericardium. Associated procedures were mitral valve repair in 32 and subaortic membrane resection in 3.

RESULTS

early mortality was 1.4% (1 patient). Median follow-up was 94 months. Sixty (83.3%) survivors had insignificant aortic regurgitation. Reoperation was required in 7 (9.6%) patients: for autograft dysfunction alone in 2, autograft failure and failed mitral valve repair in 2, autograft dysfunction with severe pulmonary homograft regurgitation in 1, severe homograft aortic valve regurgitation in 1, and right ventricular outflow tract obstruction in 1. There were 4 (5.4%) late deaths. Actuarial reoperation-free, event-free, and aortic valve dysfunction-free survival were 92.5% ±4%, 93.4% ±3.3 %, 94% ±2.9%, 86.2% ±4.3%, respectively, at 94 months.

CONCLUSIONS

aortic valve replacement with biological substitutes is associated with acceptable hemodynamics and midterm results.

摘要

背景

本研究旨在评估采用生物替代物（包括同种异体移植物、自体肺动脉移植物（Ross手术）和自体心包主动脉瓣重建术（Duran技术））对儿童进行主动脉瓣置换术的结果。

方法

1992年3月至2009年7月期间，73例主动脉瓣疾病患儿（平均年龄11.8±2.7岁）接受了使用生物替代物的主动脉瓣置换术，这些替代物包括同种异体移植物、自体肺动脉移植物以及自体心包主动脉瓣重建术。相关手术包括32例二尖瓣修复术和3例主动脉下膜切除术。

结果

早期死亡率为1.4%（1例患者）。中位随访时间为94个月。60例（83.3%）幸存者的主动脉瓣反流不明显。7例（9.6%）患者需要再次手术：2例仅因自体移植物功能障碍，2例因自体移植物功能衰竭和二尖瓣修复失败，1例因自体移植物功能障碍合并严重肺动脉同种异体移植物反流，1例因严重同种异体主动脉瓣反流，1例因右心室流出道梗阻。有4例（5.4%）晚期死亡。在94个月时，无再次手术、无事件和无主动脉瓣功能障碍的精算生存率分别为92.5%±4%、93.4%±3.3%、94%±2.9%、86.2%±4.3%。