Department of Cardiothoracic, Transplantation and Vascular Surgery, Hannover Medical School, Hannover, Germany.
Thorac Cardiovasc Surg. 2021 Jun;69(4):308-313. doi: 10.1055/s-0039-1693654. Epub 2019 Jul 22.
Aortic valve-sparing root replacement (David's procedure) is an especially appealing treatment option for young patients. Here, we present the short-, mid, and long-term outcomes of this operation in adolescent patients.
Between September 1994 and March 2014, 29 patients aged 6 to 21 years underwent the David-I procedure at our center. We conducted a retrospective study with follow-up.
The mean age was 16.8 ± 3.4 years and 90% ( = 26) were male. Marfan's syndrome was present in 86% ( = 25) of cases. Ninety-seven percent ( = 28) of cases were performed electively, and one case (3%) was performed emergently for acute aortic dissection type A. There were no early perioperative deaths (0%). Follow-up, which was completed on 100% of patients, comprised a total of 394 patient years and a mean follow-up time of 13.6 ± 5.4 years. The estimates for survival at 1, 5, and 10 years after initial surgery were 100, 97, and 93%, respectively. During follow-up, there were four (14%) late deaths and five (17%) aortic valve-related reoperations. The 1-, 5-, and 10-year estimates for freedom from valve-related reoperation were 100, 86, and 83%, respectively. The perioperative mortality for these five reoperations was 0%.
Aortic valve-sparing root replacement can be performed in adolescents with a very low perioperative risk. Long-term survival seems to be affected by connective tissue diseases.
保留主动脉瓣的根部替换术（David 手术）是年轻患者特别有吸引力的治疗选择。在这里，我们报告了该手术在青少年患者中的短期、中期和长期结果。
1994 年 9 月至 2014 年 3 月期间，我院中心对 29 名年龄在 6 至 21 岁的患者进行了 David-I 手术。我们进行了一项回顾性研究和随访。
平均年龄为 16.8 ± 3.4 岁，90%（26 例）为男性。马凡综合征占 86%（25 例）。97%（28 例）为择期手术，1 例（3%）为急性 A 型主动脉夹层行急诊手术。无早期围手术期死亡（0%）。随访完成率为 100%，共随访 394 患者年，平均随访时间为 13.6 ± 5.4 年。初始手术后 1、5 和 10 年的生存率估计分别为 100%、97%和 93%。随访期间，有 4 例（14%）晚期死亡和 5 例（17%）主动脉瓣相关再次手术。瓣膜相关再次手术的 1、5 和 10 年无事件生存率分别为 100%、86%和 83%。这 5 例再次手术的围手术期死亡率为 0%。
保留主动脉瓣的根部替换术可在青少年中安全施行，围手术期风险非常低。长期生存率似乎受到结缔组织疾病的影响。
