三步标准化儿童二尖瓣成形手术在儿童容量负荷型二尖瓣反流中的应用  

Efficacy of 3-Step Standardized Mitral Valvuloplasty for Pediatric Patients With Volume-overloaded Mitral Regurgitation

作　　者：窦铮 毛凤群 马凯[1] 逄坤静[3] 张本青[1] 芮璐[1] 何奇彧 刘禹泽 李守军[1,2] DOU Zheng;MAO Fengqun;MA Kai;PANG Kunjing;ZHANG Benqing;RUI Lu;HE Qiyu;LIU Yuze;LI Shoujun(Pediatric Cardiac Surgery Center,National Center for Cardiovascular Diseases and Fuwai Hospital,Chinese Academy of Medical Sciences and Peking Union Medical College,Beijing 100037,China;State Key Laboratory of Cardiovascular Disease,National Center for Cardiovascular Diseases and Fuwai Hospital,Chinese Academy of Medical Sciences and Peking Union Medical College,Beijing 100037,China;Echocardiography Center,National Center for Cardiovascular Diseases and Fuwai Hospital,Chinese Academy of Medical Sciences and Peking Union Medical College,Beijing 100037,China)

机构地区：[1]中国医学科学院北京协和医学院国家心血管病中心阜外医院小儿外科中心,北京100037 [2]中国医学科学院北京协和医学院国家心血管病中心阜外医院心血管疾病国家重点实验室,北京100037 [3]中国医学科学院北京协和医学院国家心血管病中心阜外医院超声影像中心,北京100037

出　　处：《中国循环杂志》2024年第2期148-155,共8页Chinese Circulation Journal

基　　金：中央高水平医院临床科研业务费(2022-GSP-GG-19);北京市科技计划(Z201100005520001)。

摘　　要：目的:探索儿童容量负荷型二尖瓣反流的最佳外科成形策略。方法:回顾2020年4月至2022年3月期间在中国医学科学院阜外医院接受初次二尖瓣成形术的110例容量负荷型二尖瓣反流患者,平均年龄(14.5±15.1)个月,男性42例(38.2%)。其中69例患者接受三步标准化儿童二尖瓣成形手术(标准化组),41例患者接受单纯瓣环环缩术(单纯环缩组)。倾向性评分匹配后,共纳入38对患者。比较两组主要终点事件(二尖瓣功能衰竭和术后心力衰竭)发生率。结果:在26.3(19.8,32.9)个月的电话随访及11.9(7.5,14.8)个月的超声心动图随访期间未发生全因死亡,共有1例(0.8%)患者发生院内计划外的二次成形手术,7例患者(单纯环缩组:标准化组=3:4)在术后6个月及以后的超声心动图随访提示中到大量二尖瓣反流复发,9例患者(单纯环缩组:标准化组=5:4)出院1个月后超声心动图提示心力衰竭,两组间差异无统计学意义。倾向性评分匹配后,标准化组体外循环时间[113(90,132)min vs.90(77,114)min]和主动脉阻断时间[80(61,92)min vs.62(49,83)min]均显著长于单纯环缩组(P均<0.05),其余结果差异均无统计学意义。基于年龄进行亚组分析,<1岁患者标准化组主要终点事件发生率(8.2%vs.26.9%P=0.041)和术后心力衰竭发生率(4.1%vs.19.2%,P=0.045)均显著低于单纯环缩组,且单纯环缩组术后末次超声心动图随访提示平均左心室舒张末期内径标准分数(LVEDD Z值)仍>2。结论:三步标准化儿童二尖瓣成形手术患者围术期恢复和术后转归并不劣于单纯瓣环环缩术患者;而对于<1岁的容量负荷型二尖瓣反流患者,该术式术后心力衰竭和主要终点发生率更低,更具推广意义。Objectives:This study aims to investigate optimal surgical management strategies for pediatric patients diagnosed with volume-overloaded mitral regurgitation.Methods:A comprehensive retrospective analysis was conducted on a cohort of 110 pediatric patients who underwent primary mitral valve repair for volume-overloaded mitral regurgitation at Fuwai Hospital between April 2020 and March 2022.The cohort,with an average age of(14.5±15.1)months and 38.2%males,was divided into standardized group for patients receiving 3-step standardized mitral valvuloplasty(n=69)and annuloplasty group for patients undergoing annuloplasty only(n=41).After propensity score matching,a total of 38 pairs of patients were included,comparing the primary endpoint(functional mitral failure and postoperative heart failure)between the two groups.Results:Over a median follow-up of 26.3(19.8,32.9)months,and with a median echocardiographic follow-up of 11.9(7.5,14.8)months,no death was recorded.Among the cases,one patient(0.8%)necessitated unplanned reoperation;and seven patients(6.4%)experienced a recurrence of moderate-severe mitral regurgitation as observed through echocardiography beyond 6 months post-surgery.Additionally,nine patients developed heart failure at one month post-discharge.Above events were similar between the two groups.Following propensity score matching,patients in the standardized group demonstrated significantly longer cardiopulmonary bypass and aortic cross-clamp times compared to the annuloplasty group(both P<0.05),other outcomes were similar between the two groups.Subgroup analysis based on age indicated that infants(<1 year old)in the standardized group exhibited a significantly lower incidence of major endpoint events compared to the annuloplasty group.Additionally,postoperative echocardiography in annuloplasty group indicated that Z score of left ventricular end diastolic diameter was still greater than 2 during the latest follow-up.Conclusions:Patients with volume-overloaded mitral regurgitation in the standardized g

关 键 词：二尖瓣反流 瓣膜修复 容量负荷 标准化策略 先天性心脏病 

分 类 号：R54[医药卫生—心血管疾病]