Myers Patrick O, Cikirikcioglu Mustafa, Tissot Cécile, Christenson Jan T, Beghetti Maurice, Kalangos Afksendiyos
Division of Cardiovascular Surgery, Geneva University Hospitals, Geneva, Switzerland.
J Heart Valve Dis. 2012 Sep;21(5):650-4.
Triple valve replacement has poor early and long-term results, particularly in children, and few data are available on triple valve repair. Herein are reported the single-center, long-term results of combined aortic, mitral, and tricuspid valve repair in rheumatic children.
Ten children (mean age 12 +/- 3 years) with severe rheumatic aortic, mitral, and tricuspid regurgitation underwent triple valve repair over a 17-year period, using a tailored cusp extension to repair the aortic valve, and ring annuloplasty and Carpentier's techniques to repair the mitral and tricuspid valves.
There were no early deaths. During a median follow up of 58 months (range: 3 months to 16 years), no late death occurred and four patients (40%) required reoperation at a median of three years (range: 2.7 to 12 years). Reoperations included one for mitral valve replacement, one for aortic valve replacement, and two for aortic and mitral valve replacements. Freedom from reoperation was 100% at one year, 63 +/- 17% at three, five, and 10 years, and 47 +/- 19% at 15 years.
In this particularly challenging patient group, triple valve repair provided satisfactory initial and mid-term results, with a high burden of reoperation in the long term, allowing a median of three years of growth and subsequent placement of a larger valve at the time of actual valve replacement. This strategy might be considered a good palliative surgical approach.
三瓣膜置换术的早期和长期效果不佳，在儿童中尤为如此，且关于三瓣膜修复的数据很少。本文报告了风湿性儿童主动脉瓣、二尖瓣和三尖瓣联合修复的单中心长期结果。
10名患有严重风湿性主动脉瓣、二尖瓣和三尖瓣反流的儿童（平均年龄12±3岁）在17年期间接受了三瓣膜修复，采用定制的瓣叶延长术修复主动脉瓣，采用瓣环成形术和卡彭蒂埃技术修复二尖瓣和三尖瓣。
无早期死亡病例。在中位随访58个月（范围：3个月至16年）期间，无晚期死亡病例，4例患者（40%）在中位3年（范围：2.7至12年）时需要再次手术。再次手术包括1例二尖瓣置换、1例主动脉瓣置换以及2例主动脉瓣和二尖瓣置换。术后1年免于再次手术的比例为100%，3年、5年和10年时为63±17%，15年时为47±19%。
在这个特别具有挑战性的患者群体中，三瓣膜修复提供了令人满意的初期和中期结果，但长期再次手术负担较高，可使患者在中位3年的时间内生长，随后在实际瓣膜置换时植入更大的瓣膜。这种策略可被视为一种良好的姑息性手术方法。
