Du Chuhao,Dong Shuo,Sun Zhiqiang,et al.Comparative study on the clinical efficacy and safety of aortic valve angioplasty and ROSS surgery in the treatment of pediatric aortic valve stenosis[J].Journal of Clinical Pediatric Surgery,2026,(01):55-58.[doi:10.3760/cma.j.cn101785-202407022]
主动脉瓣成形术与ROSS手术治疗小儿主动脉瓣狭窄的临床疗效及安全性对比研究
- Title:
- Comparative study on the clinical efficacy and safety of aortic valve angioplasty and ROSS surgery in the treatment of pediatric aortic valve stenosis
- Keywords:
- Aortic Valve Stenosis; Surgical Procedures; Operative; Child
- 摘要:
- 目的 比较小儿主动脉瓣狭窄行主动脉瓣成形术和ROSS手术的患儿特点及手术结局,探讨儿童主动脉瓣病变的合适治疗策略。方法 回顾性分析中国医学科学院阜外医院2022年5月至2024年4月由单一术者完成手术治疗的62例主动脉瓣狭窄患儿资料。根据手术方式分为主动脉瓣成形术组(n=30)和ROSS手术组(n=32),其中主动脉瓣成形术组进一步分为加心包片组(n=20)和不加心包片组(n=10)。对比各组患儿的基本情况(手术年龄、主动脉瓣病理生理等)、临床资料(主动脉瓣压差、主动脉瓣反流程度、主动脉瓣环直径等)、治疗情况(术后主动脉瓣压差、术后主动脉瓣反流程度)、术后并发症和住院期间死亡率。结果 主动脉瓣成形术组手术年龄为(5.66±3.81)岁;ROSS手术组手术年龄为(8.61±4.43)岁。主动脉瓣成形术组与ROSS手术组相比,主动脉瓣峰值压差更低[(65.01±36.77) mmHg比(97.48±28.04) mmHg,P<0.05],主动脉瓣环直径差异无统计学意义[(15.22±4.98) mm比(15.67±3.26) mm,P=0.678],肺动脉瓣环直径更小[(14.87±4.91) mm比(18.50±2.96) mm,P<0.05], 术后主动脉瓣峰值压差更大[(23.64±17.05) mmHg比(7.64±8.27) mmHg,P＜0.001]。两组术后均无一例死亡。在主动脉瓣成形术组中,加心包片组与不加心包片组相比,术后主动脉瓣峰值压差[(20.98±11.77) mmHg比(28.98±24.42) mmHg,P=0.347]和术后主动脉瓣反流程度[(0.70±0.73)分比(1.20±1.62)分,P=0.373]差异均无统计学意义。结论 小儿主动脉瓣狭窄的术式选择需要依据患儿年龄、主动脉瓣病变等特点谨慎选择,ROSS手术在低龄患儿中仍然安全有效。
- Abstract:
- Objective To compare the characteristics and surgical outcomes of children with aortic valve stenosis undergoing aortic valvuloplasty versus the Ross procedure,and to explore the optimal treatment strategy for pediatric aortic valve disease. Methods A retrospective analysis was conducted on 62 pediatric patients with aortic valve stenosis who underwent surgery by a single surgeon at Fuwai Hospital of the Chinese Academy of Medical Sciences from May 2022 to April 2024.Patients were divided into aortic valvuloplasty group (n=30) and Ross procedure group (n=32).The valvuloplasty group was further subdivided into a pericardial patch subgroup (n=20) and a non-patch subgroup (n=10).Baseline data (age at surgery,valve pathophysiology,etc.),clinical parameters (aortic valve gradient,regurgitation grade,annulus diameter),treatment outcomes (postoperative gradient,regurgitation),complications,and in-hospital mortality were compared. Results The mean age at surgery was 5.66±3.81 years in the valvuloplasty group and valvuloplasty group 8.61±4.43 years in the Ross group.Compared to the Ross group,the valvuloplasty group had a lower preoperative peak aortic gradient (65.01±36.77 mmHg vs.97.48±28.04 mmHg,P<0.05),similar aortic annulus diameter (15.22±4.98 mm vs.15.67±3.26 mm,P=0.678),and smaller pulmonary annulus diameter (14.87±4.91 mm vs.Ross group:18.50±2.96 mm,P<0.005).The postoperative peak aortic gradient was significantly higher in the valvuloplasty group (23.64±17.05 mmHg vs.7.64±8.27 mmHg,P<0.001).No postoperative deaths occurred in either group.Within the valvuloplasty group,there were no significant differences between the patch and non-patch subgroups in terms of postoperative peak gradient (20.98±11.77 mmHg vs.28.98±24.42 mmHg,P=0.347) or regurgitation grade (0.70±0.73 vs.1.20±1.62,P=0.373). Conclusions Surgical approach for pediatric aortic valve stenosis should be selected based on age and lesion characteristics.The Ross procedure remains a safe and effective option even for younger children.
参考文献/References:
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[3] Zhu MZL,Konstantinov IE,Wu DM,et al.Aortic valve repair versus the Ross procedure in children[J].J Thorac Cardiovasc Surg,2023,166(5):1279-1288.e1.DOI:10.1016/j.jtcvs.2023.03.028.
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备注/Memo
收稿日期:2024-7-10。
基金项目:中央高水平医院临床科研项目(零余额2023—GSP—QN—19)
通讯作者:杨克明,Email:13801217526@163.com