10 岁以下儿童二尖瓣修复：麻烦还是成功？
Mitral Valve Repair in Children Below Age 10 Years: Trouble or Success?
机构信息
Department of Cardiovascular Surgery, German Heart Center Munich, Technische Universität München, Munich, Germany; Insure (Institute for Translational Cardiac Surgery), Department of Cardiovascular Surgery, German Heart Center Munich, Technische Universität München, Munich, Germany; Department of Pediatric and Congenital Heart Surgery, German Heart Center Munich, Technische Universität München, Munich, Germany.
Department of Cardiovascular Surgery, German Heart Center Munich, Technische Universität München, Munich, Germany; Insure (Institute for Translational Cardiac Surgery), Department of Cardiovascular Surgery, German Heart Center Munich, Technische Universität München, Munich, Germany.
出版信息
Ann Thorac Surg. 2020 Dec;110(6):2082-2087. doi: 10.1016/j.athoracsur.2020.02.057. Epub 2020 Mar 30.
BACKGROUND
Mitral valve (MV) repair in children is challenging because of the broad spectrum of lesions and anticipated patient growth. The purpose of the study was to evaluate the outcome of MV repair in children below 10 years of age.
METHODS
We reviewed all MV repair procedures performed in children below 10 years of age. Endpoints of the study were survival after MV repair and cumulative incidence of reoperation.
RESULTS
MV repair was performed in 40 patients with congenital MV disease (MVD) and in 10 patients with acquired MVD. Median age at time of repair for congenital MVD was 1.2 years (range, 14 days to 9.8 years) and for acquired MVD 1.9 years (range, 10 days to 9.9 years). Indication for MV repair was mitral regurgitation in 31 congenital MVD patients (77.5%) and in all acquired MVD patients. In patients with congenital MVD operative mortality was 5% and late mortality was 10%. No deaths occurred in patients with acquired MVD. Patients with congenital mitral regurgitation showed a better, yet not significant, 6-year survival than patients with congenital mitral stenosis (85.3% ± 8.2% vs 60% ± 18.2%, P = .1). In patients with congenital MVD cumulative incidence of reoperation at 6 years was 38.6% ± 8.3%.
CONCLUSIONS
In children below 10 years of age, MV repair is an effective treatment option for MVD. However it often just delays the time to valve replacement.
背景
由于病变范围广泛和预期患者生长，儿童二尖瓣（MV）修复具有挑战性。本研究的目的是评估 10 岁以下儿童二尖瓣修复的结果。
方法
我们回顾了所有在 10 岁以下儿童中进行的 MV 修复手术。研究的终点是 MV 修复后的生存率和再次手术的累积发生率。
结果
40 例先天性 MV 疾病（CMD）患儿和 10 例获得性 MV 疾病患儿接受了 MV 修复。先天性 CMD 患者修复时的中位年龄为 1.2 岁（范围 14 天至 9.8 岁），获得性 MV 疾病为 1.9 岁（范围 10 天至 9.9 岁）。31 例先天性 CMD 患者（77.5%）和所有获得性 MV 疾病患者的 MV 修复指征为二尖瓣反流。先天性 CMD 患者的手术死亡率为 5%，晚期死亡率为 10%。获得性 MV 疾病患者无死亡。患有先天性二尖瓣关闭不全的患者 6 年生存率优于患有先天性二尖瓣狭窄的患者（85.3%±8.2% vs 60%±18.2%，P=0.1），但差异无统计学意义。在先天性 MV 疾病患者中，6 年时再次手术的累积发生率为 38.6%±8.3%。
结论
在 10 岁以下的儿童中，MV 修复是治疗 CMD 的有效方法。然而，它通常只是延迟了换瓣时间。
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