儿童机械动脉置换的长期结果
Michael Z L Zhu1, Edward Buratto1, Damien M Wu1
1Department of Cardiac Surgery, Royal Children's Hospital, Melbourne, Australia.; Department of Paediatrics, University of Melbourne, Melbourne, Australia.; Heart Research Group Murdoch Children's Research Institute, Melbourne, Australia.
概括
儿童的机械大动脉置换 (AVR) 在其他程序失败时提供了持久的选择. 然而,长期结果显示死亡率和重新手术的显著率,突出显示了对这种儿科机械大动脉置换策略的持续担忧.
科学领域:
- 心脏病学 心脏病学
- 儿科心脏手术 儿科心脏手术
- 生物材料在医学中的应用
背景情况:
- 当大动脉修复或罗斯手术在儿科患者中不是可行的选择时,可以考虑机械大动脉置换 (AVR).
- 这种方法带来了一些挑战,包括需要终身抗凝药,血栓形成的风险,以及儿童缺少膜生长潜力.
研究的目的:
- 在单一机构的儿科患者中审查机械AVR的长期结果.
- 将这些结果与现有的关于儿童机械AVR的文献进行比较.
主要方法:
- 在1978年至2020年期间接受机械AVR的62名儿科患者的回顾性审查.
- 对纵向数据的分析,包括生存率,重新手术率和基础诊断.
主要成果:
- 机械AVR发生时的中位数年龄为12.4岁,常见的征兆是干异常和先天性大动脉狭窄.
- 早期死亡率为3.2%. 长期卡普兰-梅尔生存率在20年达到81.9%.
- 竞争性风险分析表明,55.4%的患者在20年后仍然没有重新手术,并且随着时间的推移,重新手术的发生率会增加.
结论:
- 机械AVR是儿童患者的关键替代方案,不适合进行大动脉修复或罗斯手术.
- 长期数据强调了对死亡率的重大担忧,以及在这个人群中对大动脉重新操作的重大需求.
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