Department of Surgery, School of Medicine, University of Queensland, Brisbane, QLD, Australia.
Department of Cardiothoracic Surgery, The Prince Charles Hospital, Brisbane, QLD, Australia.
Eur J Cardiothorac Surg. 2018 Nov 1;54(5):946-952. doi: 10.1093/ejcts/ezy149.
We aimed to compare the long-term performance of pulmonary homografts and stented bioprosthetic valves in the pulmonary position in patients aged 10-20 years.
Between January 1995 and December 2015, 188 patients aged 10-20 years undergoing pulmonary valve replacement were identified retrospectively from hospital databases in both congenital cardiac centres in Brisbane. Valve performance was evaluated using previously described standard criteria. Propensity score matching was used to balance the 2 treatment groups.
Freedom from structural valve degeneration in homografts (n = 131) was 97%, 92% and 85% at 3, 5 and 10 years, respectively, and 91% and 53% at 3 and 5 years, respectively, in the bioprosthesis group (n = 57). Freedom from reintervention in homografts was 96%, 93% and 88% at 3, 5 and 10 years, respectively, and 93% and 68% at 3 and 5 years, respectively, in the bioprosthesis group. The unadjusted Cox regression analysis demonstrated that a bioprosthesis was at 5.64 times the risk of structural valve degeneration and 3.89 times the risk of reintervention. The Cox regression analysis performed on the propensity matched sample (45 pairs of patients) revealed that a bioprosthesis was at almost 10 times the risk of experiencing structural valve degeneration [hazard ratio (HR) = 9.18] and at more than 8 times the risk of undergoing a reintervention (HR = 8.34).
In our patient population, pulmonary homografts outperformed stented bioprosthetic valves within 5 years when implanted in the pulmonary position in patients aged 10-20 years. We recommend the use of a pulmonary homograft for pulmonary valve replacement in this age group in patients undergoing surgery for congenital heart disease.
我们旨在比较 10-20 岁患者中同种肺动脉瓣和带支架生物瓣在肺动脉位置的长期性能。
1995 年 1 月至 2015 年 12 月，我们从布里斯班两家先天性心脏病中心的医院数据库中回顾性地确定了 188 名 10-20 岁接受肺动脉瓣置换术的患者。使用先前描述的标准标准评估瓣膜性能。使用倾向评分匹配来平衡两组治疗。
同种移植物（n=131）无结构性瓣膜退行性变的存活率分别为 3 年、5 年和 10 年的 97%、92%和 85%，生物瓣组（n=57）的存活率分别为 3 年和 5 年的 91%和 53%。同种移植物无再干预的存活率分别为 3 年、5 年和 10 年的 96%、93%和 88%，生物瓣组分别为 3 年和 5 年的 93%和 68%。未调整的 Cox 回归分析表明，生物瓣发生结构性瓣膜退行性变的风险是同种移植物的 5.64 倍，再干预的风险是同种移植物的 3.89 倍。在倾向匹配样本（45 对患者）上进行的 Cox 回归分析表明，生物瓣发生结构性瓣膜退行性变的风险几乎是同种移植物的 10 倍[风险比（HR）=9.18]，再干预的风险超过 8 倍（HR=8.34）。
在我们的患者人群中，同种肺动脉瓣在 5 年内优于带支架的生物瓣，在 10-20 岁患者的肺动脉位置植入。我们建议在先天性心脏病手术中，在该年龄段的患者中使用同种肺动脉瓣置换肺动脉瓣。
