Choi Perry S, Sleeper Lynn A, Lu Minmin, Upchurch Patrick, Baird Christopher, Emani Sitaram M
Department of Cardiac Surgery, Boston Children's Hospital, Harvard Medical School, , Boston, Mass.
Department of Cardiology, Boston Children's Hospital, Boston, Mass; Department of Pediatrics, Harvard Medical School, Boston, Mass.
J Thorac Cardiovasc Surg. 2020 May 31. doi: 10.1016/j.jtcvs.2020.04.173.
To determine risk factors for re-replacement and death or transplant following mitral valve replacement (MVR) in children METHODS: This is a retrospective 26-year review of patients younger than 20 years of age undergoing MVR between 1992 and 2018 at single institution. Outcomes included freedom from re-MVR and transplant-free survival. Cox proportional hazards regression models assessed association between outcomes and potential risk factors.
At median age 4.2 years, 190 children underwent 290 MVR: 180 mechanical, 63 porcine, 13 pericardial, and 34 stented bovine jugular vein valves. Re-MVR occurred in 100 valves. Freedom from re-MVR at 5 and 10 years was 76% and 44%. Times to re-MVR were associated with prosthesis type (P < .001), with porcine and pericardial valves at greatest risk. Other risk factors for prosthetic failure included smaller prosthesis size and left ventricular hypoplasia. There were 9 transplants and 44 deaths. Transplant-free survival at 5 and 10 years was 81% and 76%. Prosthesis type was significantly associated with time to death/transplant in univariate analysis only (P = .021), with porcine at greater risk than mechanical. Independent risk factors for death/transplant included larger indexed geometric orifice area and longer bypass time.
In pediatric patients undergoing MVR, mechanical and stented bovine jugular vein valves were associated with increased durability compared with fixed-diameter bioprosthetic alternatives.
确定儿童二尖瓣置换术（MVR）后再次置换以及死亡或移植的危险因素。方法：这是一项对1992年至2018年在单一机构接受MVR的20岁以下患者进行的回顾性26年研究。结局包括无再次二尖瓣置换术和无移植生存。Cox比例风险回归模型评估结局与潜在危险因素之间的关联。
中位年龄4.2岁，190名儿童接受了290次二尖瓣置换术：180次使用机械瓣膜，63次使用猪瓣膜，13次使用心包瓣膜，34次使用带支架的牛颈静脉瓣膜。100个瓣膜发生了再次二尖瓣置换术。5年和10年时无再次二尖瓣置换术的比例分别为76%和44%。再次二尖瓣置换术的时间与假体类型相关（P <.001），猪瓣膜和心包瓣膜风险最高。假体失败的其他危险因素包括假体尺寸较小和左心室发育不全。有9例移植和44例死亡。5年和10年时无移植生存的比例分别为81%和76%。仅在单因素分析中，假体类型与死亡/移植时间显著相关（P = 0.021），猪瓣膜比机械瓣膜风险更高。死亡/移植的独立危险因素包括较大的指数几何开口面积和较长的体外循环时间。
在接受二尖瓣置换术的儿科患者中，与固定直径的生物假体相比，机械瓣膜和带支架的牛颈静脉瓣膜的耐用性更高。
