S. Bernheim, M. Pontailler, A. Haydar, D. Bonnet, O. Raisky
{"title":"婴儿二尖瓣手术：瓣膜成形术与置换术的比较","authors":"S. Bernheim, M. Pontailler, A. Haydar, D. Bonnet, O. Raisky","doi":"10.1016/j.acvd.2024.07.005","DOIUrl":null,"url":null,"abstract":"<div><h3>Introduction</h3><p>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.</p></div><div><h3>Objective</h3><p>Evaluate patient outcomes with mitral disease (stenosis, regurgitation or both) who had mitral valvuloplasty or replacement in the first year of life.</p></div><div><h3>Methods</h3><p>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.</p></div><div><h3>Results</h3><p>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 (<em>P</em> <!-->=<!--> <!-->0.039). The only mortality risk factor identified was replacement of the mitral valve compare to repair, HR: 9 (1.3–94.8; <em>P</em> <!-->=<!--> <!-->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.</p></div><div><h3>Conclusion</h3><p>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.</p></div>","PeriodicalId":55472,"journal":{"name":"Archives of Cardiovascular Diseases","volume":null,"pages":null},"PeriodicalIF":2.3000,"publicationDate":"2024-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":"{\"title\":\"Infant mitral valve surgery: Comparison between valvuloplasty and replacement\",\"authors\":\"S. Bernheim, M. Pontailler, A. Haydar, D. Bonnet, O. Raisky\",\"doi\":\"10.1016/j.acvd.2024.07.005\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<div><h3>Introduction</h3><p>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.</p></div><div><h3>Objective</h3><p>Evaluate patient outcomes with mitral disease (stenosis, regurgitation or both) who had mitral valvuloplasty or replacement in the first year of life.</p></div><div><h3>Methods</h3><p>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.</p></div><div><h3>Results</h3><p>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 (<em>P</em> <!-->=<!--> <!-->0.039). The only mortality risk factor identified was replacement of the mitral valve compare to repair, HR: 9 (1.3–94.8; <em>P</em> <!-->=<!--> <!-->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.</p></div><div><h3>Conclusion</h3><p>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.</p></div>\",\"PeriodicalId\":55472,\"journal\":{\"name\":\"Archives of Cardiovascular Diseases\",\"volume\":null,\"pages\":null},\"PeriodicalIF\":2.3000,\"publicationDate\":\"2024-08-01\",\"publicationTypes\":\"Journal Article\",\"fieldsOfStudy\":null,\"isOpenAccess\":false,\"openAccessPdf\":\"\",\"citationCount\":\"0\",\"resultStr\":null,\"platform\":\"Semanticscholar\",\"paperid\":null,\"PeriodicalName\":\"Archives of Cardiovascular Diseases\",\"FirstCategoryId\":\"3\",\"ListUrlMain\":\"https://www.sciencedirect.com/science/article/pii/S1875213624002262\",\"RegionNum\":3,\"RegionCategory\":\"医学\",\"ArticlePicture\":[],\"TitleCN\":null,\"AbstractTextCN\":null,\"PMCID\":null,\"EPubDate\":\"\",\"PubModel\":\"\",\"JCR\":\"Q2\",\"JCRName\":\"CARDIAC & CARDIOVASCULAR SYSTEMS\",\"Score\":null,\"Total\":0}","platform":"Semanticscholar","paperid":null,"PeriodicalName":"Archives of Cardiovascular Diseases","FirstCategoryId":"3","ListUrlMain":"https://www.sciencedirect.com/science/article/pii/S1875213624002262","RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q2","JCRName":"CARDIAC & CARDIOVASCULAR SYSTEMS","Score":null,"Total":0}
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.
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.
求助内容：
应助结果提醒方式：
京公网安备 11010802042870号
