Results after mitral valve replacement with mechanical prostheses in young children
Results after mitral valve replacement with mechanical prostheses in young children
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DOI：
10.1016/j.jtcvs.2009.10.038
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发表时间：
2010-05-01
影响因子：
6
通讯作者：
Canver, Charles C.
中科院分区：
文献类型：
--
作者：
Alsoufi, Bahaaldin;Manlhiot, Cedric;Canver, Charles C.
目的：探讨8岁以下儿童二尖瓣置换术后的预后。方法：回顾1990 ~ 2006年二尖瓣置换术患者的病历。竞争风险方法确定了死亡、重复瓣膜置换术和无再次手术生存的时间相关患病率和相关因素。结果：共有79例患者，中位年龄24个月（40天-8岁）接受了91例二尖瓣置换术（10例重复手术）。95%的病例基础病理为先天性心脏病。46例患者（58%）既往有手术史。手术死亡率为18% 2岁及以下为30% 2岁以上为6%竞争风险分析显示，首次二尖瓣置换术后10年，40%的患者在没有重复置换术的情况下死亡，20%的患者进行了第二次置换术，40%的患者在没有进一步置换术的情况下存活。与死亡相关的因素包括假体尺寸/患者体重比较高（P < 0.0001）和交叉夹时间较长（P < 0.0001）。第二次置换术在首次置换术后6 +/- 4年对10例幸存者进行了必要的置换术。在第二次置换时，植入更大的假体（平均24毫米，而最初为19毫米）。重复MVR与手术年龄较小相关（p = 0.006）。11%的医院幸存者最终需要植入永久性心脏起搏器。结论：8岁以下儿童二尖瓣置换术后死亡率和重复瓣膜置换术很常见，尤其是年龄较小且瓣膜明显过大的患者。在瓣膜再手术时，可以植入更大的假体，这表明环状生长持续。[J] .中华胸心外科杂志2010；39:1189-96。
Objective: We examined outcomes after mitral valve replacement in children younger than 8 years.Methods: Medical records of patients who underwent mitral valve replacement from 1990 to 2006 were reviewed. Competing-risks methodology determined time-related prevalence and associated factors for death, repeated valve replacement, and survival without reoperation.Results: In total, 79 patients, median age 24 months (40 days-8 years) underwent 91 mitral valve replacements (10 had repeated procedures). Underlying pathology was congenital heart disease in 95% of cases. Forty-six patients (58%) had undergone previous operations. Operative mortality was 18%, 30% for those 2-years old and younger and 6% for those older than 2 years. Competing-risks analysis showed that 10 years after initial mitral valve replacement, 40% of patients had died without repeated replacement, 20% had undergone a second replacement, and 40% remained alive without further replacement. Factors associated with death included higher prosthesis size/patient weight ratio (P < .0001) and longer crossclamp time (P < .0001). Second replacement 6 +/- 4 years after initial replacement was necessary for 10 survivors. At second replacement, larger prostheses were implanted (mean 24 mm vs 19 mm initially). Repeated MVR was associated with younger age at surgery (p = .006). Permanent pacemaker implantation was eventually needed by 11% of hospital survivors.Conclusions: Mortality and repeated valve replacement are common after mitral valve replacement in children younger than 8 years, especially younger patients with significantly oversized valves. At valve reoperation, larger prostheses could be implanted, suggesting continued annular growth. (J Thorac Cardiovasc Surg 2010; 139: 1189-96)