Department of Pediatric Cardiac Surgery, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy.
Multifactorial Disease and Complex Disease Research Area, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy.
Eur J Cardiothorac Surg. 2022 Sep 2;62(4). doi: 10.1093/ejcts/ezac183.
The aim of this study was to elucidate predictors of death and reintervention after mitral valve (MV) surgery in children.
A single-centre retrospective study was performed enrolling 142 patients younger than 18 years who underwent primary index surgical mitral repair or replacement at Bambino Gesù Children's Hospital in Rome from July 1982 to April 2020. Patients with complete, transitional or partial atrioventricular septal defect and patients with single ventricle physiology were excluded. Patients were stratified according to the age group: group 1 (<1 year old), group 2 (1-5 years old) and group 3 (>5 years old). The composite primary outcome was freedom from death or transplant. The secondary outcome was freedom from redo MV surgery.
Transplant-free survival was 89% at 5 years and 88% at 10 years. Stratified by age, group 1 had poorer outcome in comparison with other groups (log-rank test P = 0.105). Both univariate and multivariate analyses showed that age <1 year was a significant risk factor for death or transplant (P = 0.044). Age <1 year was associated with increased risk of reoperation (aHR = 3.38, P = 0.009), while the presence of genetic syndrome (aHR = 0.22) and preoperative EF% (aHR = 0.97) were protective factors for reoperation.
The overall survival and freedom from reoperation in children undergoing MV surgery still need improvements. Younger age was a significant risk factor for death and reintervention both after repair and replacement of the MV. In particular, infants and neonates have a three-fold risk for death compared to children.
本研究旨在阐明儿童二尖瓣（MV）手术后死亡和再次干预的预测因素。
对 1982 年 7 月至 2020 年 4 月在罗马 Bambino Gesù 儿童医院接受初次二尖瓣修复或置换的 142 名年龄小于 18 岁的患者进行了单中心回顾性研究。排除完全性、过渡性或部分性房室间隔缺损以及单心室生理患者。根据年龄组将患者分层：第 1 组（<1 岁）、第 2 组（1-5 岁）和第 3 组（>5 岁）。主要复合终点为无死亡或移植。次要终点为无再次 MV 手术。
无移植生存率在 5 年时为 89%，在 10 年时为 88%。按年龄分层，与其他组相比，第 1 组的结果较差（对数秩检验 P=0.105）。单因素和多因素分析均表明，年龄<1 岁是死亡或移植的显著危险因素（P=0.044）。年龄<1 岁与再次手术风险增加相关（aHR=3.38，P=0.009），而存在遗传综合征（aHR=0.22）和术前 EF%（aHR=0.97）是再次手术的保护因素。
行 MV 手术的儿童的总体生存率和免于再次手术的情况仍需改善。年龄较小是 MV 修复和置换后死亡和再干预的显著危险因素。特别是婴儿和新生儿的死亡风险是儿童的三倍。
