Chetan Devin, Szabo Adrienn B, Fan Chun-Po S, Morgan Conall T, Villemain Olivier, Chaturvedi Rajiv R, Benson Lee N, Honjo Osami
Division of Cardiology, The Labatt Family Heart Centre, The Hospital for Sick Children, Toronto, Ontario, Canada; Department of Pediatrics, University of Toronto, Toronto, Ontario, Canada.
Rogers Computational Program, Ted Rogers Centre for Heart Research, Peter Munk Cardiac Centre, University Health Network, Toronto, Ontario, Canada.
Ann Thorac Surg. 2023 Mar;115(3):778-783. doi: 10.1016/j.athoracsur.2022.11.019. Epub 2022 Dec 5.
The purpose of this study was to compare outcomes of Melody mitral valve to mechanical mitral valve replacement (MVR) for young children.
Children who underwent Melody MVR from 2014 to 2020 were case-matched to mechanical MVR patients. Transplant-free survival and cumulative incidence of reintervention were compared. A subanalysis was performed for infants aged < 1 year (9 Melody MVRs and their matches).
Twelve children underwent Melody MVR. Two children (17%) salvaged from mechanical support died. Five of 10 survivors (50%) had subsequent MVR. At 1 and 3 years, transplant-free survival (Melody: 83%, 83%; mechanical: 83%, 67%; P = .180) and reintervention (Melody: 9%, 39%; mechanical: 0%, 18%; P = .18) were equivalent between groups. For children < 1 year of age, Melody MVR had a modest survival benefit (Melody: 89%, 89%; mechanical: 80%, 60%; P = .046), while rate of reintervention remained equivalent (Melody: 13%, 32%; mechanical: 0%, 22%; P = .32).
For patients < 1 year old, Melody MVR offers a promising alternative and is a reasonable bridge to mechanical MVR, which can be performed safely at an older age. Further studies are necessary to corroborate these findings.
本研究旨在比较Melody二尖瓣置换术与机械二尖瓣置换术（MVR）在幼儿中的治疗效果。
2014年至2020年接受Melody MVR的儿童与接受机械MVR的患者进行病例匹配。比较无移植生存率和再次干预的累积发生率。对年龄<1岁的婴儿进行了亚组分析（9例Melody MVR及其匹配病例）。
12名儿童接受了Melody MVR。2名从机械支持中挽救过来的儿童（17%）死亡。10名幸存者中有5名（50%）随后接受了MVR。在1年和3年时，两组间的无移植生存率（Melody：83%，83%；机械：83%，67%；P = 0.180）和再次干预率（Melody：9%，39%；机械：0%，18%；P = 0.18）相当。对于<1岁的儿童，Melody MVR有适度的生存获益（Melody：89%，89%；机械：80%，60%；P = 0.046），而再次干预率仍然相当（Melody：13%，32%；机械：0%，22%；P = 0.32）。
对于1岁以下的患者，Melody MVR提供了一种有前景的替代方案，是向机械MVR的合理过渡，机械MVR可在较大年龄安全进行。需要进一步研究来证实这些发现。
