Zweng T N, Bluett M K, Mosca R, Callow L B, Bove E L
Division of Thoracic Surgery, University of Michigan Medical Center, Ann Arbor 48109.
Ann Thorac Surg. 1989 May;47(5):720-4. doi: 10.1016/0003-4975(89)90126-4.
Between 1976 and 1986, 19 children aged 1 month to 5 years underwent replacement of the mitral (systemic atrioventricular) valve. Indications for valve replacement included isolated congenital mitral stenosis (n = 2), valve dysfunction associated with a more complex procedure (n = 15), and failed valvuloplasty (n = 2). Seven different valve types were used; nine were mechanical valves and ten were bioprosthetic valves. There were 6 hospital deaths (32%; 70% confidence limits, 20% to 47%). Among the 13 survivors there were 3 late deaths at a mean of 14 months after operation. The late deaths were unrelated to valve malfunction. Thromboembolic events occurred in 2 patients, both with mechanical valves. One minor bleeding complication occurred among 10 patients on a regimen of Coumadin (crystalline warfarin sodium). Five patients, all with bioprostheses, required a second valve replacement. Indications for reoperation included prosthetic valve regurgitation (n = 1) and calcific stenosis (n = 4). No early or late deaths occurred after second valve replacement. Survival was 51% +/- 12% (standard error) at 112 months after valve replacement. Analysis failed to identify age, weight, sex, previous operation, underlying cardiac lesion, or prosthesis size and type as significant risk factors for mortality. Mechanical valves had a lower reoperation rate compared with bioprostheses. These data suggest that although mitral valve replacement within the first 5 years of life is associated with a high operative and late mortality, satisfactory long-term palliation for many patients can be achieved. Mechanical valves are superior to bioprosthetic valves, and offer the best long-term results.
1976年至1986年间，19名年龄在1个月至5岁的儿童接受了二尖瓣（体循环房室瓣）置换术。瓣膜置换的适应证包括单纯先天性二尖瓣狭窄（n = 2）、与更复杂手术相关的瓣膜功能障碍（n = 15）以及瓣膜成形术失败（n = 2）。使用了7种不同类型的瓣膜；9个是机械瓣膜，10个是生物瓣膜。有6例医院死亡（32%；70%可信区间，20%至47%）。在13名幸存者中，有3例晚期死亡，平均发生在术后14个月。晚期死亡与瓣膜功能障碍无关。2例患者发生血栓栓塞事件，均为机械瓣膜。在接受香豆素（结晶华法林钠）治疗的10例患者中发生了1例轻微出血并发症。5例患者，均为生物瓣膜，需要再次进行瓣膜置换。再次手术的适应证包括人工瓣膜反流（n = 1）和钙化性狭窄（n = 4）。再次瓣膜置换术后未发生早期或晚期死亡。瓣膜置换术后112个月时的生存率为51%±12%（标准误）。分析未能确定年龄、体重、性别、既往手术、潜在心脏病变或假体尺寸和类型为死亡率的重要危险因素。与生物瓣膜相比，机械瓣膜的再次手术率较低。这些数据表明，尽管在生命的前5年内进行二尖瓣置换术与较高的手术死亡率和晚期死亡率相关，但许多患者仍可实现满意的长期姑息治疗。机械瓣膜优于生物瓣膜，并能提供最佳的长期效果。
