Department of Cardiac Surgery, Royal Children's Hospital, Melbourne, Australia; Department of Pediatrics, University of Melbourne, Melbourne, Australia.
Department of Pediatrics, Royal Darwin Hospital, Darwin, Australia; Menzies School of Health Research, Darwin, Australia.
Ann Thorac Surg. 2019 Sep;108(3):792-797. doi: 10.1016/j.athoracsur.2019.03.085. Epub 2019 May 2.
It has been shown that mitral valve repair is superior to mechanical replacement in children with rheumatic heart disease; however there are limited data on the factors affecting the long-term durability of repaired mitral valves. This study describes outcomes after rheumatic mitral valve repair, with adaptation of a risk score to clarify some novel predictors of repair instability.
A total of 79 children (median age, 11.4 years) with rheumatic heart disease underwent their first mitral valve surgery between 1997 and 2015. Patients with concomitant aortic and tricuspid repair were included. Mean follow-up time was 7.72 years. Mitral valve deterioration (defined as cardiac death, reoperation, or recurrent moderate to severe valvular disease) was used as a key end point. Preoperative echocardiographs were analyzed and graded with respect to valvular mobility, subvalvular apparatus alteration, and function.
All patients underwent successful mitral valve repair. Seven patients died during follow-up. Kaplan-Meier analysis demonstrated survival at 15 years to be 83%. A total of 38 patients were deemed to have deterioration in mitral valve function, with a rate of freedom from deterioration at 15 years of 28%. The presence of an immobile anterior mitral leaflet preoperatively and the technique of posterior patch extension were shown to be significant determinants of mitral valve deterioration.
The outcomes after mitral repair for rheumatic heart disease in the young were in keeping with those reported in previous studies. Although the survival was high, long-term valve stability was poor. These findings suggest that the preoperative finding of a restricted anterior mitral leaflet is a negative predictor of repair durability.
已有研究表明，在患有风湿性心脏病的儿童中，二尖瓣修复优于机械置换；然而，关于影响修复二尖瓣长期耐久性的因素的数据有限。本研究描述了风湿性二尖瓣修复后的结果，并对风险评分进行了调整，以明确一些修复不稳定的新预测因素。
1997 年至 2015 年间，共有 79 例患有风湿性心脏病的儿童接受了首次二尖瓣手术。包括同时进行主动脉瓣和三尖瓣修复的患者。平均随访时间为 7.72 年。以心脏死亡、再次手术或复发性中度至重度瓣膜疾病为主要终点。对术前超声心动图进行分析，并根据瓣叶活动度、瓣下装置改变和功能进行分级。
所有患者均成功完成二尖瓣修复。随访期间有 7 例患者死亡。Kaplan-Meier 分析显示，15 年生存率为 83%。共有 38 例患者被认为二尖瓣功能恶化，15 年无恶化生存率为 28%。术前前二尖瓣叶活动受限和后补片延伸技术是二尖瓣恶化的显著决定因素。
风湿性心脏病年轻患者二尖瓣修复的结果与先前研究报告的结果一致。尽管生存率较高，但长期瓣膜稳定性较差。这些发现表明，术前前二尖瓣叶受限是修复耐久性的负预测因素。
