DeBoer D A, Robbins R C, Maron B J, McIntosh C L, Clark R E
Surgery Branch, National Heart, Lung and Blood Institute, National Institutes of Health, Bethesda, Maryland 20892.
Ann Thorac Surg. 1990 Jul;50(1):69-73. doi: 10.1016/0003-4975(90)90090-s.
Fifty-one patients, aged 1 to 18 years, having aortic valvotomy for congenital valvar aortic stenosis between 1956 and 1986 were followed up. The average age at operation was 11.5 years, with an operative mortality of 3.9%. The aortic valve gradient decreased from a mean preoperative value of 91 mm Hg to 27 mm Hg postoperatively. Current follow-up was 90% and averaged 16.8 years. Late cardiac mortality was 17.6%, with actuarial survival of 93.7% at 10 and 15 years, 81.8% at 20 and 25 years, and 70.9% at 28 years. Nineteen patients required reoperation (39%) at a mean of 17.7 years postoperatively, with a reoperation-free survival of 98% at 10 years. The reoperation rate accelerated in the following decade to 3.3% per year. Ten patients without reoperation were evaluated by continuous-wave Doppler echocardiography. The mean gradient was 21.6 mm Hg, and 90% had mild to moderate aortic insufficiency. This study confirms the efficacy of valvotomy in this age group and suggests that long-term survival and time to reoperation may be longer than previously reported.
对1956年至1986年间接受先天性瓣膜性主动脉狭窄主动脉瓣切开术的51例1至18岁患者进行了随访。手术时的平均年龄为11.5岁，手术死亡率为3.9%。主动脉瓣压差从术前平均91mmHg降至术后27mmHg。目前的随访率为90%，平均随访时间为16.8年。晚期心脏死亡率为17.6%，10年和15年的精算生存率为93.7%，20年和25年为81.8%，28年为70.9%。19例患者（39%）术后平均17.7年需要再次手术，10年无再次手术生存率为98%。在接下来的十年中，再次手术率加速至每年3.3%。对10例未再次手术的患者进行了连续波多普勒超声心动图评估。平均压差为21.6mmHg，90%的患者有轻度至中度主动脉瓣关闭不全。本研究证实了该年龄组瓣膜切开术的疗效，并表明长期生存率和再次手术时间可能比先前报道的更长。
