Department of Cardiovascular Surgery, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, 167# Beilishi Road, Xicheng District, Beijing, 100037, China.
Department of Ultrasound, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, 167# Beilishi Road, Xicheng District, Beijing, 100037, China.
Gen Thorac Cardiovasc Surg. 2021 Oct;69(10):1383-1391. doi: 10.1007/s11748-021-01597-2. Epub 2021 Mar 3.
To summarize the experience of mitral valve (MV) repair with artificial chordae replacement in children, and analyze early and intermediate outcomes.
From January 2011 to May 2019, all patients (< 18 years) who received MV repair with artificial chordae replacement were retrospectively reviewed. Freedom from MV reoperation, MV dysfunction, moderate or severe MR were estimated by the Kaplan-Meier curve and log-rank test.
A total of 30 patients were included in this study. According to our definition, 15 patients had simple lesions and 15 patients had complex lesions. During 36 months' follow-up (range 3-97 months), two patients received MV reoperation and seven patients developed MV dysfunction, including six patients with moderate or severe MR and one patient with mitral stenosis. Freedom from MV reoperation at 1, 5 and 8 years were 100%, 91.3% and 91.3%, respectively. And freedom from MV dysfunction at 1, 3 and 5 year were 96.0%, 77.1% and 61.8%, respectively. Five-year freedom from MV dysfunction showed significant differences between patients with simple lesions and patients with complex lesions (100% vs 32.7%, log-rank P = 0.008), and between patients aged less than 12 years and patients aged more than 12 year (33.5% vs 90.0%, log-rank P = 0.025).
The early and intermediate outcomes of mitral valve repair with artificial chordae replacement were acceptable in children, and the outcomes were optimal in patients with simple lesions, and patients aged more than 12 years.
总结儿童二尖瓣（MV）修复中人工腱索置换的经验，并分析早期和中期结果。
从 2011 年 1 月至 2019 年 5 月，回顾性分析所有接受 MV 修复并采用人工腱索置换的患者（<18 岁）。采用 Kaplan-Meier 曲线和对数秩检验估计 MV 再次手术、MV 功能障碍、中重度 MR 的无事件发生率。
本研究共纳入 30 例患者。根据我们的定义，15 例患者为单纯病变，15 例患者为复杂病变。在 36 个月的随访期间（范围 3-97 个月），2 例患者接受 MV 再次手术，7 例患者出现 MV 功能障碍，包括 6 例中重度 MR 和 1 例二尖瓣狭窄。1、5、8 年 MV 无再次手术率分别为 100%、91.3%和 91.3%。1、3、5 年 MV 无功能障碍率分别为 96.0%、77.1%和 61.8%。单纯病变患者和复杂病变患者（100%比 32.7%，log-rank P=0.008）以及年龄<12 岁和年龄>12 岁患者（33.5%比 90.0%，log-rank P=0.025）的 5 年 MV 无功能障碍率有显著差异。
在儿童中，二尖瓣修复中采用人工腱索置换的早期和中期结果是可以接受的，在单纯病变患者和年龄>12 岁的患者中，结果最佳。
