Department of Cardiac Surgery, Boston Children's Hospital, Boston, Massachusetts, USA.
Department of Cardiology, Boston Children's Hospital, Boston, Massachusetts, USA; Department of Pediatrics, Harvard Medical School, Boston, Massachusetts, USA.
J Am Coll Cardiol. 2022 Sep 13;80(11):1060-1068. doi: 10.1016/j.jacc.2022.06.029.
Outcomes following congenital aortic valve (AoV) repair are plagued by progressive dysfunction of currently available leaflet substitute materials.
We compared the long-term outcomes of congenital AoV repair using porcine intestinal submucosa vs autologous pericardium (AP).
This was a single-center retrospective review of all patients who underwent congenital AoV repair with either porcine intestinal submucosa or AP from October 2009 to March 2013. The primary outcome was postdischarge (late) unplanned AoV reintervention. Secondary outcomes included number of late AoV reinterventions and a composite of at least moderate aortic regurgitation or stenosis at latest follow-up or before the first reintervention. Associations between leaflet repair material and outcomes were assessed using multivariable regression models, adjusting for prespecified patient-related and operative variables.
Of 26 porcine intestinal submucosa and 49 AP patients who met entry criteria, the median age was 11.0 years (IQR: 4.7-16.6 years). At a median follow-up of 8.5 years (IQR: 4.4-9.6 years), 17 (65.4%) porcine intestinal submucosa and 22 (44.9%) AP patients underwent at least 1 AoV reintervention. On multivariable analysis, porcine intestinal submucosa use was significantly associated with unplanned AoV reintervention (HR: 4.6; 95% CI: 2.2-9.8; P < 0.001), number of postdischarge AoV reinterventions (incidence rate ratio: 1.7; 95% CI: 1.0-2.9; P = 0.037), and at least moderate aortic regurgitation or stenosis at latest follow-up or before the first reintervention (OR: 5.0; 95% CI: 1.2-21.0; P = 0.027).
Aortic valvuloplasty with porcine intestinal submucosa is associated with earlier time to reintervention compared with autologous pericardium. The search for the ideal AoV leaflet repair material continues.
目前可用的瓣叶替代材料的进行性功能障碍困扰着先天性主动脉瓣（AoV）修复的结果。
我们比较了使用猪肠黏膜与自体心包（AP）进行先天性 AoV 修复的长期结果。
这是一项对 2009 年 10 月至 2013 年 3 月期间在单一中心接受猪肠黏膜或 AP 进行先天性 AoV 修复的所有患者进行的回顾性研究。主要结果是出院后（晚期）计划外的 AoV 再次介入。次要结果包括晚期 AoV 再次介入的数量以及在最新随访或第一次再次介入之前至少存在中度主动脉瓣反流或狭窄的复合结果。使用多变量回归模型评估瓣叶修复材料与结果之间的关系，调整了预先指定的患者相关和手术变量。
在符合入选标准的 26 例猪肠黏膜和 49 例 AP 患者中，中位年龄为 11.0 岁（IQR：4.7-16.6 岁）。中位随访 8.5 年（IQR：4.4-9.6 年）时，17 例（65.4%）猪肠黏膜和 22 例（44.9%）AP 患者至少进行了 1 次 AoV 再次介入。多变量分析显示，猪肠黏膜的使用与计划外 AoV 再次介入显著相关（HR：4.6；95%CI：2.2-9.8；P<0.001），出院后 AoV 再次介入的数量（发病率比：1.7；95%CI：1.0-2.9；P=0.037）以及在最新随访或第一次再次介入之前至少存在中度主动脉瓣反流或狭窄（OR：5.0；95%CI：1.2-21.0；P=0.027）。
与自体心包相比，猪肠黏膜主动脉瓣成形术与更早的再介入时间相关。对于理想的 AoV 瓣叶修复材料的探索仍在继续。
