d'Udekem Yves, Kisamori Eiri, Ishigami Shuta, Konstantinov Igor E
Division of Cardiovascular Surgery, Children's National Heart Institute, Children's National Hospital, Washington, DC, USA.
Department of Cardiac Surgery, The Royal Children's Hospital, Melbourne, Australia.
Ann Cardiothorac Surg. 2023 May 31;12(3):253-258. doi: 10.21037/acs-2023-avs1-0029. Epub 2023 May 18.
Aortic valve-sparing procedures have been established as a mainstream treatment option for adult patients with aortic root aneurysms. However, data regarding their use in the pediatric population is limited. This study reports on our experience with aortic valve-sparing procedures in children.
A retrospective review was conducted of all patients who underwent an aortic valve-sparing procedure at the Royal Children's Hospital, Melbourne, Australia between April 2006 and April 2016. Clinical and echocardiographic data were analyzed.
The study included 17 patients, with a median age of 15.7 years and a majority of patients being male (82.4%). The most common diagnosis was transposition of great arteries after arterial switch operation, followed by Loeys-Dietz syndrome and Marfan syndrome. Preoperative echocardiography showed more than moderate aortic regurgitation in 94.1% of the patients. The David procedure was performed in all 17 patients, with no mortality during follow-up. Reoperation was required in 29.4% of patients, and 23.5% required aortic valve replacement. Freedom from reoperation for aortic valve replacement at 1, 5, and 10 years was 93.8%, 93.8% and 68.2% respectively.
Aortic valve-sparing surgery can be successfully performed in the pediatric population. However, it requires a highly skilled surgeon due to the often dysplastic or distorted nature of these valves and the need for additional procedures on the aortic valve leaflets.
保留主动脉瓣手术已成为成年主动脉根部瘤患者的主流治疗选择。然而，关于其在儿科人群中的应用数据有限。本研究报告了我们在儿童保留主动脉瓣手术方面的经验。
对2006年4月至2016年4月期间在澳大利亚墨尔本皇家儿童医院接受保留主动脉瓣手术的所有患者进行回顾性研究。分析临床和超声心动图数据。
该研究纳入17例患者，中位年龄15.7岁，大多数患者为男性（82.4%）。最常见的诊断是动脉调转术后大动脉转位，其次是洛伊斯-迪茨综合征和马凡综合征。术前超声心动图显示94.1%的患者存在中重度以上主动脉瓣反流。所有17例患者均接受了大卫手术，随访期间无死亡病例。29.4%的患者需要再次手术，23.5%的患者需要进行主动脉瓣置换。主动脉瓣置换术后1年、5年和10年免于再次手术的比例分别为93.8%、93.8%和68.2%。
保留主动脉瓣手术在儿科人群中可以成功实施。然而，由于这些瓣膜通常发育不良或变形，且需要对主动脉瓣叶进行额外手术，因此需要技术高超的外科医生。
