Journal of Chest Surgery

  • 제56권6호
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  • Pages.394-402
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  • 2023
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  • 2765-1606(pISSN)
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  • 2765-1614(eISSN)
대한심장혈관흉부외과학회 (The Korean Society for Thoracic and Cardiovascular Surgery)
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Outcomes after Mechanical Aortic Valve Replacement in Children with Congenital Heart Disease

  • Joon Young Kim (Division of Pediatric Cardiac Surgery, Asan Medical Center, University of Ulsan College of Medicine) ;
  • Won Chul Cho (Department of Thoracic and Cardiovascular Surgery, Gangneung Asan Hospital, University of Ulsan College of Medicine) ;
  • Dong-Hee Kim (Division of Pediatric Cardiac Surgery, Asan Medical Center, University of Ulsan College of Medicine) ;
  • Eun Seok Choi (Division of Pediatric Cardiac Surgery, Asan Medical Center, University of Ulsan College of Medicine) ;
  • Bo Sang Kwon (Division of Pediatric Cardiac Surgery, Asan Medical Center, University of Ulsan College of Medicine) ;
  • Tae-Jin Yun (Division of Pediatric Cardiac Surgery, Asan Medical Center, University of Ulsan College of Medicine) ;
  • Chun Soo Park (Division of Pediatric Cardiac Surgery, Asan Medical Center, University of Ulsan College of Medicine)
  • 투고 : 2023.06.05
  • 심사 : 2023.08.10
  • 발행 : 2023.11.05
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초록

Background: The optimal choice of valve substitute for aortic valve replacement (AVR) in pediatric patients remains a matter of debate. This study investigated the outcomes following AVR using mechanical prostheses in children. Methods: Forty-four patients younger than 15 years who underwent mechanical AVR from March 1990 through March 2023 were included. The outcomes of interest were death or transplantation, hemorrhagic or thromboembolic events, and reoperation after mechanical AVR. Adverse events included any death, transplant, aortic valve reoperation, and major thromboembolic or hemorrhagic event. Results: The median age and weight at AVR were 139 months and 32 kg, respectively. The median follow-up duration was 56 months. The most commonly used valve size was 21 mm (14 [31.8%]). There were 2 in-hospital deaths, 1 in-hospital transplant, and 1 late death. The overall survival rates at 1 and 10 years post-AVR were 92.9% and 90.0%, respectively. Aortic valve reoperation was required in 4 patients at a median of 70 months post-AVR. No major hemorrhagic or thromboembolic events occurred. The 5- and 10-year adverse event-free survival rates were 81.8% and 72.2%, respectively. In univariable analysis, younger age, longer cardiopulmonary bypass time, and smaller valve size were associated with adverse events. The cut-off values for age and prosthetic valve size to minimize the risk of adverse events were 71 months and 20 mm, respectively. Conclusion: Mechanical AVR could be performed safely in children. Younger age, longer cardiopulmonary bypass time and smaller valve size were associated with adverse events. Thromboembolic or hemorrhagic complications might rarely occur.

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참고문헌

  1. Mazzitelli D, Guenther T, Schreiber C, Wottke M, Michel J, Meisner H. Aortic valve replacement in children: are we on the right track? Eur J Cardiothorac Surg 1998;13:565-71. https://doi.org/10.1016/s1010-7940(98)00069-4
  2. Wada J, Yokoyama M, Hashimoto A, et al. Long-term follow-up of artificial valves in patients under 15 years old. Ann Thorac Surg 1980;29:519-21. https://doi.org/10.1016/s0003-4975(10)61696-7
  3. Clarke DR, Campbell DN, Hayward AR, Bishop DA. Degeneration of aortic valve allografts in young recipients. J Thorac Cardiovasc Surg 1993;105:934-42. https://doi.org/10.1016/s0022-5223(19)34168-6
  4. Elkins RC, Knott-Craig CJ, Ward KE, Lane MM. The Ross operation in children: 10-year experience. Ann Thorac Surg 1998;65:496-502. https://doi.org/10.1016/s0003-4975(97)01373-8
  5. Edmunds LH Jr, Clark RE, Cohn LH, Grunkemeier GL, Miller DC, Weisel RD. Guidelines for reporting morbidity and mortality after cardiac valvular operations. The American Association for Thoracic Surgery, Ad Hoc Liaison Committee for Standardizing Definitions of Prosthetic Heart Valve Morbidity. Ann Thorac Surg 1996;62:932-5. https://doi.org/10.1016/s0003-4975(96)00531-0
  6. Bouhout I, Ba PS, El-Hamamsy I, Poirier N. Aortic valve interventions in pediatric patients. Semin Thorac Cardiovasc Surg 2019;31:277-87. https://doi.org/10.1053/j.semtcvs.2018.10.009
  7. Henaine R, Roubertie F, Vergnat M, Ninet J. Valve replacement in children: a challenge for a whole life. Arch Cardiovasc Dis 2012;105:517-28. https://doi.org/10.1016/j.acvd.2012.02.013
  8. El-Hamamsy I, Eryigit Z, Stevens LM, et al. Long-term outcomes after autograft versus homograft aortic root replacement in adults with aortic valve disease: a randomised controlled trial. Lancet 2010;376:524-31. https://doi.org/10.1016/S0140-6736(10)60828-8
  9. Sharabiani MT, Dorobantu DM, Mahani AS, et al. Aortic valve replacement and the Ross operation in children and young adults. J Am Coll Cardiol 2016;67:2858-70. https://doi.org/10.1016/j.jacc.2016.04.021
  10. Donald JS, Wallace FR, Naimo PS, et al. Ross operation in children: 23-year experience from a single institution. Ann Thorac Surg 2020;109:1251-9. https://doi.org/10.1016/j.athoracsur.2019.10.070
  11. Bove T, Bradt N, Martens T, et al. The pulmonary autograft after the Ross operation: results of 25-year follow-up in a pediatric cohort. Ann Thorac Surg 2021;111:159-67. https://doi.org/10.1016/j.athoracsur.2020.06.027
  12. Alsoufi B, Al-Halees Z, Manlhiot C, et al. Mechanical valves versus the Ross procedure for aortic valve replacement in children: propensity-adjusted comparison of long-term outcomes. J Thorac Cardiovasc Surg 2009;137:362-70. https://doi.org/10.1016/j.jtcvs.2008.10.010
  13. Etnel JR, Elmont LC, Ertekin E, et al. Outcome after aortic valve replacement in children: a systematic review and meta-analysis. J Thorac Cardiovasc Surg 2016;151:143-52. https://doi.org/10.1016/j.jtcvs.2015.09.083
  14. Knight JH, Sarvestani AL, Ibezim C, et al. Multicentre comparative analysis of long-term outcomes after aortic valve replacement in children. Heart 2022;108:940-7. https://doi.org/10.1136/heartjnl2021-319597
  15. Jonas RA. The Ross procedure is not the procedure of choice for the teenager requiring aortic valve replacement. Semin Thorac Cardiovasc Surg Pediatr Card Surg Annu 2005;8:176-80. https://doi.org/10.1053/j.pcsu.2005.01.019
  16. Masuda M, Kado H, Ando Y, et al. Intermediate-term results after the aortic valve replacement using bileaflet mechanical prosthetic valve in children. Eur J Cardiothorac Surg 2008;34:42-7. https://doi.org/10.1016/j.ejcts.2008.04.005
  17. Xu Z, Shi Q, Mei J, Tan Y. Long-term outcomes after mechanical aortic valve replacement with aortic root enlargement in adolescents. J Card Surg 2017;32:133-7. https://doi.org/10.1111/jocs.13085
  18. Myers PO, Mokashi SA, Horgan E, et al. Outcomes after mechanical aortic valve replacement in children and young adults with congenital heart disease. J Thorac Cardiovasc Surg 2019;157:329-40. https://doi.org/10.1016/j.jtcvs.2018.08.077
  19. Dhareshwar J, Sundt TM 3rd, Dearani JA, Schaff HV, Cook DJ, Orszulak TA. Aortic root enlargement: what are the operative risks? J Thorac Cardiovasc Surg 2007;134:916-24. https://doi.org/10.1016/j.jtcvs.2007.01.097
  20. Nishimura RA, Otto CM, Bonow RO, et al. 2017 AHA/ACC focused update of the 2014 AHA/ACC Guideline for the management of patients with valvular heart disease: a report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines. Circulation 2017;135:e1159-95. https://doi.org/10.1161/CIR.0000000000000503