井上球囊二尖瓣成形术：对以预后不佳为主的人群进行长期临床和超声心动图随访

Inoue balloon mitral valvuloplasty: long-term clinical and echocardiographic follow-up of a predominantly unfavourable population.

作者信息

Hildick-Smith D J, Taylor G J, Shapiro L M

机构信息

Cardiac Unit, Papworth Hospital, Cambridge, U.K.

出版信息

Eur Heart J. 2000 Oct;21(20):1690-7. doi: 10.1053/euhj.2000.2241.

DOI:10.1053/euhj.2000.2241

PMID:11032696

Abstract

AIMS

To assess long-term outcome in a typical Western population of predominantly unfavourable patients undergoing Inoue balloon mitral valvuloplasty. Outcome amongst patients has only been undertaken in the medium term. Long-term echocardiographic data in particular are scarce.

METHODS

Inoue mitral valvuloplasty was attempted in 106 patients. There were six technical failures; the procedure was therefore completed in 100 patients, who underwent annual clinical and echocardiographic follow-up.

RESULTS

Patients were aged 63.5+/-10. 3 years. 82% were female. Unfavourable characteristics included age >65 (52%), NYHA class III or IV (87%), >/=1 significant co-morbidity (63%), atrial fibrillation (82%), previous surgical commissurotomy (25%) and echocardiographic score >8 (59%, mean 8.9+/-2.1). Mitral valve area increased from 0.98+/-0.23 to 1.54+/-0.31 cm(2). There were three major complications. Post-procedure, symptoms improved in 88% of patients. Haemodynamic success (mitral valve area increase >50%, final mitral valve area >1.5 cm(2), mitral regurgitation </=grade 2) was achieved in 61% of cases. Mean follow-up was 4.3+/-1. 4 years. Survival was 97%, 88% and 82% at 1, 3 and 6 years. Event-free survival (freedom from death, mitral valve replacement or repeat valvuloplasty) was 96%, 82% and 56% at 1, 3 and 6 years. Freedom from restenosis (loss of >50% gain in mitral valve area, mitral valve area <1.5cm (2)) was 98%, 92% and 75% at 1, 3 and 6 years. Pre-procedural predictors of event-free survival were male sex, absence of co-morbidities, lower echocardiographic score and smaller left atrial diameter.

CONCLUSIONS

In a Western population with predominantly unfavourable characteristics for mitral valvuloplasty, long-term outcome post-procedure is reasonable. A moderate increase in mitral valve area can be achieved at low procedural risk, and the subsequent rate of restenosis is low. Nonetheless, 6 years after the procedure, half of the patients will have required further intervention or died. For fitter patients willing to accept significant operative risk, mitral valve replacement remains a valuable alternative.

摘要

目的

评估接受井上球囊二尖瓣成形术的典型西方人群中主要为病情不利患者的长期预后。此前仅对患者的中期预后进行了研究。特别是长期超声心动图数据稀缺。

方法

对106例患者尝试进行井上二尖瓣成形术。有6例技术失败；因此该手术在100例患者中完成，这些患者接受了每年一次的临床和超声心动图随访。

结果

患者年龄为63.5±10.3岁。82%为女性。不利特征包括年龄>65岁（52%）、纽约心脏协会（NYHA）III或IV级（87%）、≥1种严重合并症（63%）、心房颤动（82%）、既往外科交界切开术（25%）以及超声心动图评分>8（59%，平均8.9±2.1）。二尖瓣面积从0.98±0.23增加至1.54±0.31平方厘米。发生了3例主要并发症。术后，88%的患者症状改善。61%的病例获得血流动力学成功（二尖瓣面积增加>50%，最终二尖瓣面积>1.5平方厘米，二尖瓣反流≤2级）。平均随访时间为4.3±1.4年。1年、3年和6年的生存率分别为97%、88%和82%。无事件生存率（无死亡、二尖瓣置换或再次瓣膜成形术）在1年、3年和6年时分别为96%、82%和56%。无再狭窄率（二尖瓣面积增加丧失>50%，二尖瓣面积<1.5平方厘米）在1年、3年和6年时分别为98%、92%和75%。无事件生存率的术前预测因素为男性、无合并症、较低的超声心动图评分和较小的左心房直径。