Huang Jiaxi, Zhang Wenbo, Jia Bing, Chen Gang, Mi Yaping, Shi Qiqi, Shan Yaping, Zhang Huifeng
Department of Pediatric Cardiothoracic Surgery, Children's Hospital of Fudan University, Shanghai, China.
Transl Pediatr. 2023 Nov 28;12(11):1981-1991. doi: 10.21037/tp-23-289. Epub 2023 Nov 24.
The treatment of aortic valve diseases in children remains a great challenge. We aim to report outcomes and midterm follow-up data of our confluent neocuspidization technique with pericardium for aortic valve replacement (AVR) in children.
A retrospective analysis was performed on all 20 children who underwent the confluent neocuspidization technique with pericardium at Children's Hospital of Fudan University from March 2017 to May 2022. Outcome measures included echocardiographic measurements, surgical intervention, and mortality.
A total of 20 patients (17 males 3 females), with a median age of 7.5 years [min-max, 0.3-12 years; interquartile range (IQR), 4.4-9.7 years], a median body weight of 24.0 kg (min-max, 6.0-52.3 kg; IQR, 15.6-31.0 kg), and median aortic valve annulus size before surgery of 19.0 mm (min-max, 11.0-25.0 mm; IQR, 17.1-21.5 mm), underwent the neocuspidization technique with pericardium (17 autologous pericardia and 3 bovine patch). With 50% of bicuspid aortic valve and 50% of tricuspid, they were respectively diagnosed as aortic stenosis (AS) (7/20, 35%), aortic regurgitation (AR) (8/20, 40%) and mixed AS and AR (AS & AR) (5/20, 25%). The median postoperative follow-up time was 19 months (min-max, 5-61 months; IQR, 16.3-35 months). The peak pressure gradient across the aortic valve decreased from 81.0±37.0 mmHg in AS group and AS & AR group before surgery to 25.9±15.8 mmHg within 24 hours after surgery (P<0.001) and was mostly around 25 mmHg during follow-up. All patients presented mild or less than mild regurgitation within 24 hours after surgery. There were no hospital mortalities. Three patients needed reintervention during follow-up. There was one late death related to mitral valve stenosis.
Though the confluent neocuspidization technique with pericardium provided immediate relief of significant AS or regurgitation, the midterm outcome was suboptimal. More research is needed to find the optimal material for AVR.
儿童主动脉瓣疾病的治疗仍然是一项巨大挑战。我们旨在报告采用心包进行汇合新瓣叶化技术治疗儿童主动脉瓣置换术（AVR）的结果及中期随访数据。
对2017年3月至2022年5月在复旦大学附属儿科医院接受心包汇合新瓣叶化技术的所有20例患儿进行回顾性分析。观察指标包括超声心动图测量、手术干预和死亡率。
共20例患者（男17例，女3例），中位年龄7.5岁[最小-最大，0.3 - 12岁；四分位间距（IQR），4.4 - 9.7岁]，中位体重24.0 kg（最小-最大，6.0 - 52.3 kg；IQR，15.6 - 31.0 kg），术前主动脉瓣环大小中位值为19.0 mm（最小-最大，11.0 - 25.0 mm；IQR，17.1 - 21.5 mm），接受了心包汇合新瓣叶化技术（17例自体心包和3例牛心包补片）。其中主动脉瓣二叶式畸形占50%，三叶式畸形占50%，分别诊断为主动脉狭窄（AS）（7/20，35%）、主动脉反流（AR）（8/20，40%）和AS合并AR（AS & AR）（5/20，25%）。术后中位随访时间为19个月（最小-最大，5 - 61个月；IQR，16.3 - 35个月）。AS组和AS & AR组术前主动脉瓣跨瓣峰值压差从81.0±37.0 mmHg降至术后24小时内的25.9±15.8 mmHg（P<0.001）且随访期间大多维持在25 mmHg左右。所有患者术后24小时内均表现为轻度或轻度以下反流。无院内死亡。3例患者在随访期间需要再次干预。有1例晚期死亡与二尖瓣狭窄有关。
尽管采用心包的汇合新瓣叶化技术能立即缓解严重的AS或反流，但中期结果并不理想。需要更多研究来寻找AVR的最佳材料。
