Guariento Alvise, Cattapan Claudia, Doulamis Ilias P, Tobota Zdzislaw, Maruszewski Bohdan, Bleiweis Mark S, Jacobs Jeffrey P, Sarris George E, Vida Vladimiro
Pediatric and Congenital Cardiac Surgery Unit, Department of Cardiac, Thoracic, Vascular Sciences and Public Health, University of Padua, Padua, Italy.
Department of Surgery, Lahey Clinic, Tufts University School of Medicine, Burlington, MA, USA.
Eur J Cardiothorac Surg. 2025 Jun 3;67(6). doi: 10.1093/ejcts/ezaf101.
Aortic valve surgery is a crucial treatment for congenital and acquired aortic disease in adolescents and young adults. This study evaluated outcomes in this group by analysing data from the European Congenital Heart Surgeons Association Congenital Cardiac Database (ECCDB).
A retrospective review included patients aged 10-18 years from the ECCDB who underwent aortic valve surgery between 2013 and 2022. The primary outcome was operative mortality, defined as death within 30 days or during hospitalization. Secondary outcomes included reoperations and postoperative complications. Risk factors for mortality were identified using multivariable logistic regression analysis, and surgical trends were evaluated.
A total of 2129 patients were included, with the majority undergoing valve replacement, followed by valve repair and the Ross procedure. Patients receiving valve replacement were typically older and larger. Over the decade, there was an increase in the use of the Ross procedure. Reoperations were more frequent in the repair group, while postoperative complications were more common in the replacement group. The overall mortality rate was 1.5%. Independent risk factors for mortality included longer cardiopulmonary bypass (CPB) times (odds ratio 1.1, P < 0.001) and annulus enlargement (odds ratio 3.8, P = 0.02). CPB durations exceeding 240 min increased the risk of death. The Ross procedure, particularly in isolated cases without annulus enlargement, was associated with a low mortality rate of 0.4%.
Aortic valve surgery in adolescents and young adults is complex, with outcomes influenced by CPB time and annulus enlargement. The Ross procedure shows excellent results despite its technical demands.
主动脉瓣手术是青少年和年轻成人先天性及后天性主动脉疾病的关键治疗方法。本研究通过分析欧洲先天性心脏外科医生协会先天性心脏病数据库（ECCDB）的数据，评估了该群体的手术结果。
一项回顾性研究纳入了2013年至2022年间在ECCDB接受主动脉瓣手术的10至18岁患者。主要结局为手术死亡率，定义为30天内或住院期间死亡。次要结局包括再次手术和术后并发症。使用多变量逻辑回归分析确定死亡的危险因素，并评估手术趋势。
共纳入2129例患者，大多数接受瓣膜置换术，其次是瓣膜修复术和罗斯手术。接受瓣膜置换术的患者通常年龄较大且体型较大。在这十年间，罗斯手术的使用有所增加。修复组再次手术更为频繁，而置换组术后并发症更为常见。总体死亡率为1.5%。死亡的独立危险因素包括体外循环（CPB）时间延长（比值比1.1，P<0.001）和瓣环扩大（比值比3.8，P=0.02）。CPB持续时间超过240分钟会增加死亡风险。罗斯手术，尤其是在无瓣环扩大的孤立病例中，死亡率低至0.4%。
青少年和年轻成人的主动脉瓣手术复杂，结果受CPB时间和瓣环扩大的影响。尽管罗斯手术对技术要求较高，但效果良好。
