婴儿二尖瓣手术：瓣膜成形术与置换术的比较

IF 2.3 3区医学 Q2 CARDIAC & CARDIOVASCULAR SYSTEMS Archives of Cardiovascular Diseases Pub Date : 2024-08-01 DOI:10.1016/j.acvd.2024.07.005

S. Bernheim, M. Pontailler, A. Haydar, D. Bonnet, O. Raisky

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引用次数: 0

摘要

引言婴儿二尖瓣置换术与高死亡率和高再介入率有关。方法描述性单中心回顾性研究，包括所有在 22 年内（2001-2023 年）接受二尖瓣修复或置换术的 1 岁以下儿童。评估的结果包括：早期死亡率（30 天）、晚期死亡率、是否需要再次干预。手术时的中位年龄为 147 天，中位体重为 5.1 千克。39名患者接受了二尖瓣修复术，17名患者接受了二尖瓣置换术。重症监护室平均住院时间为 7 天。总体住院时间中位数为 11 天。死亡率为 17.9%（出院前为 7.1%）。30天总存活率为96%，1年总存活率为86%，3年总存活率为82%。与二尖瓣置换术相比，二尖瓣修复术患者的总生存率明显更高（P = 0.039）。与修复术相比，二尖瓣置换术是唯一的死亡风险因素，HR：9 (1.3-94.8; P = 0.038)。23名患者（41.1%）需要再次介入治疗。修复后1年的无再介入生存率为81%，5年为65%，10年为46%。置换术后1年的无再介入生存率为74%，5年和10年为55%。对数秩检验显示，二尖瓣修复术和置换术的无再介入生存率没有差异。虽然二尖瓣成形术在降低死亡率方面效果更佳，但它通常只是一种临时措施，可推迟瓣膜置换的需要。

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Infant mitral valve surgery: Comparison between valvuloplasty and replacement

Introduction

Mitral valve replacement in infants is associated with high mortality and a significant rate of re-intervention. There is limited research examining the long-term consequences of valvuloplasty in this particular age group.

Objective

Evaluate patient outcomes with mitral disease (stenosis, regurgitation or both) who had mitral valvuloplasty or replacement in the first year of life.

Methods

Descriptive monocentric retrospective study including all children with mitral valve repair or replacement under 1 year of age over a period of 22 years (2001–2023). The outcomes assessed were: early mortality (at 30 days), late mortality, need for re-intervention.

Results

Fifty-six patients were identified. Median age at surgery was 147 days and median weight was 5.1 kg. Thirty-nine patients underwent mitral valve repair and 17 mitral valve replacement. Mean duration of ICU stay was 7 days. Overall median hospital stay was 11 days. Mortality rate was 17.9% (7.1% before discharge). Overall survival was 96% at 30 days, 86% at 1 year 82% at 3 years. Overall survival was significantly higher in patient with mitral valve repair compared to mitral valve replacement (P = 0.039). The only mortality risk factor identified was replacement of the mitral valve compare to repair, HR: 9 (1.3–94.8; P = 0.038). Twenty-three patients (41.1%) needed re-intervention. The re-intervention free survival rate after repair was 81% at 1 year; 65% at 5 years and 46% at 10 years. The re-intervention free survival rate after replacement was 74% at 1 year; 55% at 5 and 10 years. A log-rank test showed no difference in re-intervention free survival between mitral valve repair or replacement.

Conclusion

Mitral valve surgery in infants carries particularly high risks and is associated with a high rate of re-interventions. While mitral valvuloplasty demonstrates superior outcomes in term of mortality, it frequently serves as a temporary measure, postponing the need for valve replacement.

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来源期刊

Archives of Cardiovascular Diseases 医学-心血管系统

CiteScore

4.40

自引率

6.70%

发文量

审稿时长

34 days

期刊介绍： The Journal publishes original peer-reviewed clinical and research articles, epidemiological studies, new methodological clinical approaches, review articles and editorials. Topics covered include coronary artery and valve diseases, interventional and pediatric cardiology, cardiovascular surgery, cardiomyopathy and heart failure, arrhythmias and stimulation, cardiovascular imaging, vascular medicine and hypertension, epidemiology and risk factors, and large multicenter studies. Archives of Cardiovascular Diseases also publishes abstracts of papers presented at the annual sessions of the Journées Européennes de la Société Française de Cardiologie and the guidelines edited by the French Society of Cardiology.