Remenyi Bo, Webb Rachel, Gentles Tom, Russell Peter, Finucane Kirsten, Lee Mildred, Wilson Nigel
Green Lane Pediatric and Congenital Cardiac Services, Starship Children's Hospital, Auckland, New Zealand.
World J Pediatr Congenit Heart Surg. 2013 Apr;4(2):155-64. doi: 10.1177/2150135112474024.
Mitral valve (MV) repair offers potential advantages over replacement in patients with rheumatic heart disease (RHD). We present the first long-term study that compares MV repair with replacement in children with RHD.
Single institute retrospective review of patients with RHD under 20 years of age, who underwent their first isolated MV surgery between 1990 and 2006. Of the 81 patients, 98% were Māori or Pacific Islander. The median age was 12.7 (3-19) years. The MV was repaired in 59%, a mechanical valve replacement (MVR) took place in 35% and bioprosthetic valve replacement in 6% of the patients. Follow-up data were available for 91.4% of the patients with mean follow-up of 7.6 years (range 0-19.4 years), a total of 620 patient years. Actuarial survival at 10 and 14 years for patients with MVR was 79% and 44%, compared to 90% and 90% for patients who underwent repair (P = .06). Actuarial freedom from late reoperation at 10 and 14 years for patients with MVR was 88% and 73%, compared to 76% and 76% for patients with repair (P = .52). Actuarial freedom from thrombotic, embolic, and hemorrhagic events at 10 and 14 years for patients with MVR was 63% and 45%, compared to 100% and 100% for patients with repair P < .01).
This study shows that MV repair is superior to replacement for RHD in the young with follow-up to 19 years. Repair offers a survival advantage, greater freedom from valve-related morbidity, and long-term durability that equals that of MVR.
对于风湿性心脏病（RHD）患者，二尖瓣（MV）修复术相较于置换术具有潜在优势。我们开展了第一项针对RHD患儿的MV修复术与置换术的长期比较研究。
对1990年至2006年间首次接受单纯MV手术的20岁以下RHD患者进行单机构回顾性研究。81例患者中，98%为毛利人或太平洋岛民。中位年龄为12.7（3 - 19）岁。59%的患者接受了MV修复术，35%的患者进行了机械瓣膜置换（MVR），6%的患者进行了生物瓣膜置换。91.4%的患者有随访数据，平均随访7.6年（范围0 - 19.4年），共620患者年。MVR患者10年和14年的精算生存率分别为79%和44%，而接受修复术的患者分别为90%和90%（P = 0.06）。MVR患者10年和14年免于再次手术的精算自由度分别为88%和73%，修复术患者分别为76%和76%（P = 0.52）。MVR患者10年和14年免于血栓形成、栓塞和出血事件的精算自由度分别为63%和45%，修复术患者为100%和100%（P < 0.01）。
本研究表明，对于年轻的RHD患者，MV修复术在长达19年的随访中优于置换术。修复术具有生存优势，瓣膜相关发病率更低，且长期耐用性与MVR相当。
