Malik Tayyaba, Jaquiss Robert Douglas B, Harirah Omar, Davies Ryan R, Andersen Nicholas, Leonard Steven, Zhang Song, Reyes Karl M
Department of Cardiovascular and Thoracic Surgery, University of Texas Southwestern Medical Center and Children's Medical Center, Dallas, Texas.
School of Public Health, University of Texas Southwestern Medical Center, Dallas, Texas.
Ann Thorac Surg Short Rep. 2024 May 6;2(3):359-363. doi: 10.1016/j.atssr.2024.04.016. eCollection 2024 Sep.
In small children with left atrioventricular valve dysfunction, valve repair is preferred but some will require valve replacement. No prosthetic valve has growth potential, bioprostheses have poor durability, and mechanical prostheses have high rates of thromboembolic and hemorrhagic complications. We reviewed our experience with a modified bovine jugular vein valve designed for use in the right ventricular outflow tract (Melody valve, Medtronic) and compared this with contemporary mechanical valve replacement.
We reviewed outcomes of all left-sided atrioventricular valve replacements (AVVR) performed between January 2017 and April 2023 on patients with biventricular circulation less than 5 years old at time of surgery, N = 19. We compared mortality and major morbidity outcomes between mechanical AVVR (mAVVR, n = 14) and Melody AVVR (MAVVR, n=5).
MAVVR was performed on younger and smaller patients (5.7 ± 4.2 vs 28.4 ± 22.3 months, = .002; 6 ± 1.7 vs10 ± 5.1 kg, = .01). There were 2 early and 1 late death in the mAVVR group, and none in the MAVVR group. There was a trend towards more hemorrhagic and neurologic complications in the mAVVR group ( = .1, 0.28, respectively).
In this small series, despite its use in younger and smaller patients, our preliminary experience with the Melody valve compares favorably with our contemporaneous outcomes with mechanical prostheses by way of simpler anticoagulation management with a trend towards better overall outcomes.
在患有左房室瓣功能障碍的幼儿中，瓣膜修复是首选方法，但有些患儿需要进行瓣膜置换。没有人工瓣膜具有生长潜力，生物瓣膜耐久性差，而机械瓣膜血栓栓塞和出血并发症发生率高。我们回顾了我们使用一种改良的用于右心室流出道的牛颈静脉瓣膜（美敦力公司的Melody瓣膜）的经验，并将其与当代机械瓣膜置换术进行了比较。
我们回顾了2017年1月至2023年4月期间对手术时双心室循环小于5岁的患者进行的所有左侧房室瓣置换术（AVVR）的结果，N = 19。我们比较了机械AVVR（mAVVR，n = 14）和Melody AVVR（MAVVR，n = 5）之间的死亡率和主要并发症结果。
MAVVR手术的患者年龄更小、体型更小（5.7±4.2个月对28.4±22.3个月，P = 0.002；6±1.7千克对10±5.1千克，P = 0.01）。mAVVR组有2例早期死亡和1例晚期死亡，MAVVR组无死亡。mAVVR组有出血和神经并发症增多的趋势（分别为P = 0.1、0.28）。
在这个小系列研究中，尽管Melody瓣膜用于年龄更小、体型更小的患者，但我们对其的初步经验与同期机械瓣膜假体的结果相比具有优势，因为其抗凝管理更简单，总体结果有更好的趋势。
