Marathe Supreet P, Bell Douglas, Betts Kim, Sayed Sajid, Dunne Benjamin, Ward Cameron, Whight Chris, Jalali Homayoun, Venugopal Prem, Andrews David, Alphonso Nelson
Queensland Paediatric Cardiac Services, Queensland Children's Hospital, Brisbane, Australia.
Faculty of Medicine, University of Queensland, Brisbane, Australia.
Eur J Cardiothorac Surg. 2019 Feb 7. doi: 10.1093/ejcts/ezz021.
The aim of this study was to compare the performance of pulmonary homografts with stentless bioprosthetic valves [Medtronic Freestyle™ (Medtronic, Minneapolis, MN, USA)] in the pulmonary position in patients with congenital heart disease (CHD) younger than 20 years.
Between January 2000 and December 2017, 215 patients were retrospectively identified from hospital databases in 3 congenital heart centres in Australia. Valve performance was evaluated using standard criteria. Propensity score matching was used to balance the 2 treatment groups.
Freedom from reintervention for patients who received a pulmonary homograft (n = 163) was 96%, 88% and 81% at 5, 10 and 15 years and for patients who received a Freestyle™ valve (n = 52) was 98%, 89% and 31% at 5, 10 and 15 years, respectively. Freedom from structural valve degeneration for patients with a homograft was 92%, 87% and 77% at 5, 10 and 15 years and for patients with a Freestyle valve was 96%, 80% and 14% at 5, 10 and 15 years, respectively. In the first 10 years, there was no difference in outcomes [reintervention hazard ratios (HR) = 0.69, 95% confidence intervals (CI) (0.20-2.42), P = 0.56; structural valve degeneration HR = 0.92 (0.34-2.51), P = 0.87]. After 10 years, the recipients of the Freestyle valves were at higher risk of both outcomes [reintervention HR = 7.89; 95% CI (2.79-22.34), P < 0.001; structural valve degeneration HR = 7.41 (2.77-19.84), P < 0.001]. The findings were similar when analysed by implantation in the orthotopic position and in the propensity-matched groups.
The Freestyle stentless bioprosthetic valve is a comparable alternative to cryopreserved pulmonary homografts up to 10 years after implantation when implanted in an orthotopic pulmonary position in patients younger than 20 years with CHD.
本研究旨在比较先天性心脏病（CHD）20岁以下患者肺动脉位置植入同种异体肺动脉移植物与无支架生物瓣膜[美敦力Freestyle™（美敦力公司，美国明尼阿波利斯，MN）]的性能。
2000年1月至2017年12月，从澳大利亚3个先天性心脏病中心的医院数据库中回顾性识别出215例患者。使用标准标准评估瓣膜性能。倾向评分匹配用于平衡两个治疗组。
接受同种异体肺动脉移植物的患者（n = 163）在5、10和15年时再次干预的自由度分别为96%、88%和81%，接受Freestyle™瓣膜的患者（n = 52）在5、10和15年时分别为98%、89%和31%。同种异体移植物患者无结构性瓣膜退变的自由度在5、10和15年时分别为92%、87%和77%，Freestyle瓣膜患者在5、10和15年时分别为96%、80%和14%。在最初10年，结局无差异[再次干预风险比（HR）= 0.69，95%置信区间（CI）（0.20 - 2.42），P = 0.56；结构性瓣膜退变HR = 0.92（0.34 - 2.51），P = 0.87]。10年后，Freestyle瓣膜接受者两种结局的风险均更高[再次干预HR = 7.89；95% CI（2.79 - 22.34），P < 0.001；结构性瓣膜退变HR = 7.41（2.77 - 19.84），P < 0.001]。按原位植入和倾向匹配组分析时，结果相似。
对于20岁以下CHD患者，在原位肺动脉位置植入时，Freestyle无支架生物瓣膜在植入后10年内是与低温保存同种异体肺动脉移植物相当的替代选择。
