Department of Cardiothoracic Surgery, Erasmus University Medical Centre, Erasmus MC, Doctor Molewaterplein 40, 3015 GD, Rotterdam, Zuid-Holland, The Netherlands.
Department of Cardiac Surgery, University Hospitals Leuven, UZ Leuven Gasthuisberg, Herestraat 49, 3000, Leuven, Flanders, Belgium.
Eur Heart J. 2023 Sep 7;44(34):3231-3246. doi: 10.1093/eurheartj/ehad370.
To support decision-making in children undergoing aortic valve replacement (AVR), by providing a comprehensive overview of published outcomes after paediatric AVR, and microsimulation-based age-specific estimates of outcome with different valve substitutes.
A systematic review of published literature reporting clinical outcome after paediatric AVR (mean age <18 years) published between 1/1/1990 and 11/08/2021 was conducted. Publications reporting outcome after paediatric Ross procedure, mechanical AVR (mAVR), homograft AVR (hAVR), and/or bioprosthetic AVR were considered for inclusion. Early risks (<30d), late event rates (>30d) and time-to-event data were pooled and entered into a microsimulation model. Sixty-eight studies, of which one prospective and 67 retrospective cohort studies, were included, encompassing a total of 5259 patients (37 435 patient-years; median follow-up: 5.9 years; range 1-21 years). Pooled mean age for the Ross procedure, mAVR, and hAVR was 9.2 ± 5.6, 13.0 ± 3.4, and 8.4 ± 5.4 years, respectively. Pooled early mortality for the Ross procedure, mAVR, and hAVR was 3.7% (95% CI, 3.0%-4.7%), 7.0% (5.1%-9.6%), and 10.6% (6.6%-17.0%), respectively, and late mortality rate was 0.5%/year (0.4%-0.7%/year), 1.0%/year (0.6%-1.5%/year), and 1.4%/year (0.8%-2.5%/year), respectively. Microsimulation-based mean life-expectancy in the first 20 years was 18.9 years (18.6-19.1 years) after Ross (relative life-expectancy: 94.8%) and 17.0 years (16.5-17.6 years) after mAVR (relative life-expectancy: 86.3%). Microsimulation-based 20-year risk of aortic valve reintervention was 42.0% (95% CI: 39.6%-44.6%) after Ross and 17.8% (95% CI: 17.0%-19.4%) after mAVR.
Results of paediatric AVR are currently suboptimal with substantial mortality especially in the very young with considerable reintervention hazards for all valve substitutes, but the Ross procedure provides a survival benefit over mAVR. Pros and cons of substitutes should be carefully weighed during paediatric valve selection.
通过提供小儿主动脉瓣置换术（AVR）后已发表结果的综合概述，并基于 microsimulation 对不同瓣膜替代物的结果进行年龄特异性估计，为儿童 AVR 的决策提供支持。
对 1990 年 1 月 1 日至 2021 年 11 月 8 日期间发表的小儿 AVR（平均年龄 <18 岁）后临床结果的已发表文献进行了系统综述。纳入了报告小儿 Ross 手术、机械 AVR（mAVR）、同种异体 AVR（hAVR）和/或生物瓣 AVR 后结果的出版物。将早期风险（<30d）、晚期事件发生率（>30d）和时间事件数据汇总并输入 microsimulation 模型。共纳入 68 项研究，其中 1 项前瞻性研究和 67 项回顾性队列研究，共纳入 5259 例患者（37435 患者年；中位随访：5.9 年；范围 1-21 年）。Ross 手术、mAVR 和 hAVR 的平均年龄分别为 9.2 ± 5.6、13.0 ± 3.4 和 8.4 ± 5.4 岁。Ross 手术、mAVR 和 hAVR 的早期死亡率分别为 3.7%（95%CI，3.0%-4.7%）、7.0%（5.1%-9.6%）和 10.6%（6.6%-17.0%），晚期死亡率为 0.5%/年（0.4%-0.7%/年）、1.0%/年（0.6%-1.5%/年）和 1.4%/年（0.8%-2.5%/年）。基于 microsimulation 的前 20 年平均预期寿命为 Ross 术后 18.9 年（18.6-19.1 年）（相对预期寿命：94.8%）和 mAVR 术后 17.0 年（16.5-17.6 年）（相对预期寿命：86.3%）。基于 microsimulation 的 Ross 术后 20 年主动脉瓣再介入风险为 42.0%（95%CI：39.6%-44.6%），mAVR 术后为 17.8%（95%CI：17.0%-19.4%）。
目前小儿 AVR 的结果并不理想，尤其是在非常年幼的儿童中死亡率较高，所有瓣膜替代物都存在相当大的再介入风险，但 Ross 手术提供了优于 mAVR 的生存获益。在选择儿童瓣膜时，应仔细权衡替代物的优缺点。
Zotero 插件
