russjcardiolРоссийский кардиологический журналRussian Journal of Cardiology1560-40712618-7620«SILICEA-POLIGRAF» LLC10.15829/1560-4071-2020-3971russjcardiol-3971Research ArticleЮВЕНИЛЬНАЯ И ДЕТСКАЯ КАРДИОЛОГИЯJUVENILE AND CHILD CARDIOLOGYОтдаленные результаты и предикторы исхода реконструктивной хирургии у детей с врожденным пороком аортального клапанаLong-term outcomes of aortic valve repair in children with congenital heart disease and their predictorshttps://orcid.org/0000-0002-0444-9791АбдурахмановЗ. М.AbdurakhmanovZ. M.

ассистент кафедры хирургических болезней и реанимации

БухараКиев 

BukharaKyiv

z_abdurakhmanov@yahoo.comhttps://orcid.org/0000-0002-1893-0164ЕмецИ. Н.YemetsI. N.

д. м.н., профессор, директор

Киев

Kyiv

i_yemets@gmail.comГУ Научно-практический медицинский центр детской кардиологии и кардиохирургии Министерства здравоохранения Украины; Бухарский государственный медицинский институтУзбекистанUkrainian Children’s Cardiac Center; Bukhara State Medical InstituteUzbekistanГУ «Научно-практический медицинский центр детской кардиологии и кардиохирургии Министерства здравоохранения Украины»УкраинаUkrainian Children’s Cardiac CenterUkraine20201207202025839713971Copyright © Абдурахманов З.М., Емец И.Н., 20202020Абдурахманов З.М., Емец И.Н.Abdurakhmanov Z.M., Yemets I.N.Данная работа распространяется под лицензией Creative Commons Attribution 4.0.This work is licensed under a Creative Commons Attribution 4.0 License.https://russjcardiol.elpub.ru/jour/article/view/3971Цель

Цель. Ретроспективно проанализировать отдаленные результаты первичной реконструкции аортального клапана (РеАК) у детей.

Материал и методы

Материал и методы. 163 пациента, прооперированные с 2004 по 2019гг, были включены в исследования. Средний возраст составил 9,58±9,3 года. Пациентам выполнялись следующие методики: комиссуротомия, декальцинация, резекция ложной комиссуры, пластика по Trusler, выбривание ложной комиссуры, пликация свободных краев створок, протезирование створок, аугментация створок, субкомиссуральная аннулопластика, клапансохраняющая операция и неокуспидизация. Первичная конечная точка была композитным исходом свободы от реопераций в сочетании с более умеренной степенью аортального стеноза (АС) и аортальной недостаточности (АН), вторичная — уровнем выживаемости.

Результаты

Результаты. Показаниями к операции были АС, АН и смешанный порок у 80 (49,1%), 38 (23,3%) и 45 (27,6%) пациентов, соответственно. 10-летняя выживаемость составила 99,4%. Длительность послеоперационного наблюдения составила 3,6±1,8 лет. Свобода от повторной операции, >2 степени АН и АС, составила 95%, 70% и 47% через 1, 5 и 7 лет после операции, соответственно. При мультифакторном анализе, метод Trusler, аугментация створок, рафе “шейвинг”, применение аутоперикарда, ретракция створки, сложность выполнения пластики аортального клапана были предикторами повторной операции.

Заключение

Заключение. РеАК у детей является безопасным и эффективным методом оперативного вмешательства. Избежание выявленных предикторов значительным образом может улучшить отдаленные результаты данной операции.

Aim

Aim. To retrospectively analyze the long-term results of primary aortic valve repair (AVR) in children.

Material and methods

Material and methods. The study included 163 patients operated on from 2004 to 2019. The mean age was 9,58±9,3 years. The patients underwent commissurotomy, decalcification, raphe resection, Trusler technique, raphe shaving, free margin plication, leaflet replacement, leaflet extension, subcommissural annuloplasty, valve sparing aortic root replacement and neocuspidization. Primary endpoint was a composite outcome of freedom from reoperation, recurrent greater than moderate aortic regurgitation, stenosis, whereas secondary — overall survival.

Results

Results. The indications for the procedure were stenotic, regurgitant or mixed defect in 80 (49,1%), 38 (23,3%), and 45 (27,6%) patients, respectively. The 10-year survival rate was 99,4%. The mean follow-up was 3,6±1,8 years. Freedom from reoperation, recurrent moderate and greater aortic regurgitation, stenosis at 1,5 and 7 years was, 95%, 70% and 47%, respectively. In multivariate analysis, Trusler technique, leaflet extension, raphe shaving, use of patch, leaflet retraction, complexity of repair were predictors for composite outcome.

Conclusion

Conclusion. Reconstruction of aortic valve in children is effective and safe. Avoidance of predictors may significantly improve the long-term results of aortic valve repair.

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The authors declare that there are no conflicts of interest present.