Kubota Kana, Diller Gerhard-Paul, Kempny Aleksander, Hoschtitzky Andreas, Imai Yasushi, Kawada Masaaki, Shore Darryl, Gatzoulis Michael A
Adult Congenital Heart Centre and National Centre for Pulmonary Hypertension, Royal Brompton Hospital, London, United Kingdom.
Division of Cardiovascular Medicine, Department of Internal Medicine, Jichi Medical University, Tochigi, Japan.
Int J Cardiol Congenit Heart Dis. 2022 May 14;9:100394. doi: 10.1016/j.ijcchd.2022.100394. eCollection 2022 Sep.
Surgical pulmonary valve replacement (PVR) is the standard cardiac operation in adult patients with congenital heart disease (ACHD). We report recent experience at a large tertiary centre and examine the impact of prosthesis type on outcomes.
All surgical PVRs performed at our tertiary centre between January 2003 and December 2018 were included.
The study population included 490 patients (197 women; mean age 29.9 ± 13 years). The types of valves used were Homograft 179 (37%), Perimount 152 (31%), Mosaic 120 (24%), Hancock 31 (6%), and others 5 (1%). Seven (1.4%) early deaths occurred within 30 days after surgery. The survival rates at 1, 5, 10, and 15 years of follow-up were 98.3%, 97.7%, 96.8%, and 95.4%, respectively, whereas freedom from re-intervention was 99.8%, 96.6%, 90.2%, and 81.0%, respectively. During a mean follow-up of 6.5 ± 4.3 years, 27 (5.5%) patients required re-intervention. The type of valve used in these 27 patients during index operation showed no discernible difference in the probability of re-intervention; however, Mosaic valves required earlier re-intervention compared to Perimount valves.
Our data show no discernible difference in reoperation rates between the different types of prostheses used. On-going surveillance of patients after PVR and further research in developing a life-long prosthesis are clearly warranted.
外科肺动脉瓣置换术（PVR）是成年先天性心脏病（ACHD）患者的标准心脏手术。我们报告了一家大型三级中心的近期经验，并研究了假体类型对手术结果的影响。
纳入2003年1月至2018年12月在我们三级中心进行的所有外科PVR手术。
研究人群包括490例患者（197例女性；平均年龄29.9±13岁）。使用的瓣膜类型为同种异体移植物179例（37%）、Perimount 152例（31%）、Mosaic 120例（24%）、Hancock 31例（6%）和其他5例（1%）。7例（1.4%）早期死亡发生在术后30天内。随访1、5、10和15年的生存率分别为98.3%、97.7%、96.8%和95.4%，而无需再次干预的比例分别为99.8%、96.6%、90.2%和81.0%。在平均6.5±4.3年的随访期间，27例（5.5%）患者需要再次干预。这27例患者在首次手术时使用的瓣膜类型在再次干预的概率上没有明显差异；然而，与Perimount瓣膜相比，Mosaic瓣膜需要更早进行再次干预。
我们的数据显示，所使用的不同类型假体的再次手术率没有明显差异。显然有必要对PVR术后患者进行持续监测，并进一步研究开发终身假体。
