背景:结缔组织病(CTD)儿科患者的心血管受累危及生命,主动脉根扩张是最常见的心血管异常。我们试图确定该组中保留瓣膜的根部置换(VSRR)的长期结果,包括主动脉瘤和夹层的心血管再手术。
方法:我们对儿童CTD患者进行了回顾性分析,从2002年到2021年,他在一个中心接受了VSRR。主要终点是全因死亡和心血管再手术的复合事件。中位随访时间为8.3年,最长为20.7年。
结果:24名患有VSRR的儿科患者的中位年龄为14.4岁。Marfan综合征和Loeys-Dietz综合征影响了19例(79.2%)和5例(20.8%)患者,分别。没有过早死亡。15年生存率为91.7%。在VSRR之后的10年,主动脉瓣反流(AR)再手术的累计发生率为15.6%,主动脉瘤或夹层,是29.1%。从主要终点开始的10年自由率为53.1%。Cox多变量分析显示手术年龄较小(风险比[HR],1.279;95%置信区间[CI]1.086-1.505;P=.003)和13岁之前的VSRR(HR,5.005;95%CI1.146-21.850;P=.032)是主要终点的独立预后因素。
结论:VSRR治疗小儿CTD患者主动脉根部扩张表现出良好的长期生存率和较低的再手术率。然而,一些患者后来发展为主动脉瘤或夹层,可能需要仔细监视,特别是在年轻时接受VSRR的人。
BACKGROUND: Cardiovascular involvement in pediatric patients with connective tissue disease (CTD) is life-threatening, with aortic root dilatation being the most prevalent cardiovascular abnormality. We attempted to determine long-term outcomes of valve-sparing root replacement (VSRR) in this group, including cardiovascular reoperations for aortic aneurysm and dissection.
METHODS: We conducted a retrospective analysis of pediatric patients with CTD who received VSRR in a single center from 2002 to 2021. The primary end point was a composite event of all-cause death and cardiovascular reoperations. The median follow-up duration was 8.3 years, with a maximum of 20.7 years.
RESULTS: The median age of 24 pediatric patients who had VSRR was 14.4 years. Marfan syndrome and Loeys-Dietz syndrome affected 19 (79.2%) and 5 (20.8%) patients, respectively. There was no early death. The 15-year survival rate was 91.7%. At 10 years after VSRR, the cumulative incidence of reoperation for aortic regurgitation was 15.6%, and for aortic aneurysm or dissection, it was 29.1%. The 10-year rate of freedom from the primary end point was 53.1%. The Cox multivariable analysis revealed younger age at surgery (hazard ratio, 1.279; 95% confidence interval, 1.086-1.505; P = .003) and VSRR before 13 years of age (hazard ratio, 5.005; 95% confidence interval, 1.146-21.850; P = .032) as independent prognostic factors for the primary endpoint.
CONCLUSIONS: VSRR for aortic root dilatation in pediatric patients with CTD demonstrated good long-term survival and low reoperation rates for aortic regurgitation. However, several patients developed later aortic aneurysm or dissection, and careful surveillance may be required, particularly in those who received VSRR at younger age.