Multicentre comparative analysis of long-term outcomes after aortic valve replacement in children.
Multicentre comparative analysis of long-term outcomes after aortic valve replacement in children.
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DOI：
10.1136/heartjnl-2021-319597
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发表时间：
2022-05-25
期刊：
影响因子：
--
通讯作者：
Kochilas LK
中科院分区：
文献类型：
--
作者：
Knight JH;Sarvestani AL;Ibezim C;Turk E;McCracken CE;Alsoufi B;St Louis J;Moller JH;Raghuveer G;Kochilas LK
儿童先天性主动脉瓣疾病手术治疗的理想瓣膜替代物尚不清楚。瓣膜置换术后10-15年的预后数据有限，但对评估瓣膜置换术的寿命很重要。我们的目的是描述长达25年的死亡/心脏移植，按瓣膜替代品的类型，并评估治疗中心的潜在影响。我们的假设是自体肺动脉瓣移植患者比机械假体有更好的生存率。这是一项来自儿科心脏护理联盟的回顾性队列研究，该联盟是一个位于美国的多机构儿科心脏干预登记机构，与国家死亡指数和联合器官共享网络联系到2019年。1982-2003年接受主动脉瓣置换术（AVR）的儿童（0-20岁）。计算Kaplan-Meier无移植生存期，Cox比例风险模型估计机械AVR （M-AVR）与自体肺动脉瓣移植的风险比。在911名儿童中，AVR时的中位年龄为13.4岁（IQR=8.4-16.5）， 73%为男性。心脏移植10例，死亡153例，移植后死亡5例。自体移植物AVR术后25年无移植生存率为86.1%，M-AVR为75.9%，组织（生物假体或同种移植物）为71.2%。调整后，M-AVR仍然与死亡率/移植与自体移植增加相关（HR=1.9, 95% CI=1.1-3.4）。令人惊讶的是，在住院死亡率较高的中心接受治疗的M-AVR（而非自体移植物）患者的生存率较低。自体肺动脉瓣移植为患有主动脉瓣疾病的儿童提供了最佳的长期预后，但AVR的结果可能取决于中心的经验或患者的选择。
The ideal valve substitute for surgical intervention of congenital aortic valve disease in children remains unclear. Data on outcomes beyond 10-15 years after valve replacement are limited but important for evaluating substitute longevity. We aimed to describe up to 25-year death/cardiac transplant by type of valve substitute and assess the potential impact of treatment center. Our hypothesis was that patients with pulmonic valve autograft would have better survival than mechanical prosthetic. This is a retrospective cohort study from the Pediatric Cardiac Care Consortium, a multi-institutional US-based registry of pediatric cardiac interventions, linked with the National Death Index and United Network for Organ Sharing through 2019. Children (0-20 years old) receiving aortic valve replacement (AVR) 1982-2003 were identified. Kaplan-Meier transplant-free survival was calculated, and Cox proportional hazard models estimated hazard ratios for mechanical AVR (M-AVR) versus pulmonic valve autograft. Among 911 children, the median age at AVR was 13.4 years (IQR=8.4-16.5) and 73% were male. There were 10 cardiac transplants and 153 deaths, 5 after transplant. The 25-year transplant-free survival post AVR was 86.1% for autograft vs 75.9% for M-AVR and 71.2% for tissue (bioprosthetic or homograft). After adjustment, M-AVR remained related to increased mortality/transplant vs autograft (HR=1.9, 95% CI=1.1-3.4). Surprisingly, survival for patients with M-AVR, but not autograft, was lower for those treated in centers with higher in-hospital mortality. Pulmonic valve autograft provides the best long-term outcomes for children with aortic valve disease, but AVR results may depend on a center’s experience or patient selection.
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影响因子：
4.6
作者：
Bove, Thierry;Bradt, Nicolas;Poncelet, Alain
通讯作者：
Poncelet, Alain
DOI：
10.1177/2150135114537532
发表时间：
2014-07-01
影响因子：
0.9
作者：
Zebele, Carlo;Chivasso, Pierpaolo;Stoica, Serban
通讯作者：
Stoica, Serban
影响因子：
3.4
作者：
Simon, P;Aschauer, C;Wollenek, G
通讯作者：
Wollenek, G
影响因子：
8
作者：
Pace, Nelson D.;Oster, Matthew E.;Meyer, Robert E.
通讯作者：
Meyer, Robert E.
影响因子：
24
作者：
Buratto, Edward;Wallace, Fraser R. O.;Konstantinov, Igor E.
通讯作者：
Konstantinov, Igor E.