主动脉瓣成形与Ross手术治疗儿童重度主动脉瓣病变近中期效果的回顾性队列研究  

Short-to mid-term outcomes of aortic valve plasty versus Ross procedure in children with severe aortic valve disease:A retrospective cohort study

作　　者：谢林[1] 吴铸衡 刘靖宇 赁可[1] XIE Lin;WU Zhuheng;LIU Jingyu;DIAN Ke(Department of Cardiovascular Surgery,West China Hospital,Sichuan University,Chengdu,610041,P.R.China)

机构地区：[1]四川大学华西医院心脏大血管外科,成都610041

出　　处：《中国胸心血管外科临床杂志》2024年第12期1794-1802,共9页Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

摘　　要：目的对比主动脉瓣成形术(aortic valve plasty,AVP)及自体肺动脉瓣移植术(Ross手术)在重度主动脉瓣病变患儿中的近中期矫治效果。方法回顾性纳入2019年1月—2023年9月于四川大学华西医院心脏大血管外科接受AVP(AVP组)或Ross手术(Ross手术组)的重度主动脉瓣病变患者(年龄<18岁)。收集患儿围术期及随访资料,并进行组间比较。结果共纳入48例患儿,其中男28例、女20例,平均年龄(9.3±4.5)岁。AVP组25例,Ross手术组23例。瓣叶削薄[15/25(60.0%)]及瓣叶延展[10/25(40.0%)]是AVP组最常用的手术策略;而根部置换[12/23(52.2%)]及冠脉下再植[10/23(43.5%)]为Ross手术组的主要策略。无患儿在住院期间死亡,术后中位随访时间为16.0(7.0,30.0)个月。AVP组术后主动脉瓣峰值流速更快[2.0(1.4,2.9)m/s vs.1.2(1.0,1.5)m/s,P<0.001],两组术后主动脉瓣反流程度差异无统计学意义(P=0.127)。随访期间AVP组及Ross手术组全因再手术率及主动脉瓣再手术率相似(8.0%vs.13.0%,P=0.922;8.0%vs.0.0%,P=0.266),但AVP组主动脉瓣病变复发率更高(52.0%vs.4.3%,P<0.001)。进一步分析并未发现AVP组中与主动脉瓣病变复发相关的危险因素。结论AVP及Ross手术在儿童中具有同等的围术期安全性,术后随访期间生存率及总体再手术率相近。AVP组术后主动脉瓣病变复发率较Ross手术组更高,其具体原因仍有待进一步研究确认。Objective To compare the short-to mid-term outcomes of aortic valve plasty(AVP)and Ross surgery in children with severe aortic valve disease.Methods The patients(aged<18 years)with severe aortic valve disease who underwent AVP(an AVP group)or Ross surgery(a Ross group)at the Department of Cardiovascular Surgery,West China Hospital from January 2019 to September 2023 were retrospectively included.We compared perioperative and follow-up data between the groups.Results A total of 48 pediatric patients were included,including 28 males and 20 females,with an average age of(9.3±4.5)years.There were 25 patients in the AVP group,and 23 in the Ross group.Leaflet thinning(15/25,60.0%)and leaflet extension(10/25,40.0%)were the most common strategies used in the AVP group,while root replacement technique(12/23,52.2%)and subcoronary technique(10/23,43.5%)were the most frequently used strategies in the Ross group.There was no in-hospital death.The median follow-up time was 16.0(7.0,30.0)months.Peak flow velocity of the aortic valve was higher in the AVP group[2.0(1.4,2.9)m/s vs.1.2(1.0,1.5)m/s,P<0.001],while there was no statistical difference in the postoperative aortic valve regurgitation severity between the two groups(P=0.127).During follow-up,the overall reoperation rate and aortic valve reoperation rate were similar between the AVP group and the Ross group(8.0%vs.13.0%,P=0.922;8.0%vs.0.0%,P=0.266).The rate of recurrent aortic valve disease was higher in the AVP group(52.0%vs.4.3%,P<0.001),while further analysis failed to recognize any risk factors.Conclusion AVP and Ross procedure show similar perioperative safety,survival and reoperation rate.The rate of recurrent aortic valve disease is higher in the AVP group,but further investigations are needed to confirm the causes.

关 键 词：主动脉瓣成形 ROSS手术 儿童 近中期结局 

分 类 号：R726.5[医药卫生—儿科]