Calafiore A M, Gallina S, Di Mauro M, Gaeta F, Iacò A L, D'Alessandro S, Mazzei V, Di Giammarco G
Department of Cardiology and Cardiac Surgery, University G. D'Annunzio of Chieti, Italy.
Ann Thorac Surg. 2001 Apr;71(4):1146-52; discussion 1152-3. doi: 10.1016/s0003-4975(00)02650-3.
Mitral valve (MV) procedure for dilated cardiomyopathy is becoming popular. We analyzed the indications to MV repair or replacement according to our 10-year experience.
From January 1990 to May 2000, 49 patients with dilated cardiomyopathy (12 idiopathic and 37 ischemic) underwent MV operation, 29 repair and 20 replacement. Preoperative evaluation included measurement of MV coaptation depth (CD) as a mirror of the abnormalities of MV apparatus leading to functional mitral regurgitation.
Thirty-day mortality was 4.2% (2 patients). One-, 3-, 5-, and 10-year actuarial survival was, respectively, 90%, 87%, 78%, and 73%. The possibility of survival with at least one New York Heart Association functional class improvement was 88%, 76%, 71%, and 65%. Return of functional mitral regurgitation after MV repair was nearly inevitable; however, using a scale from 0 to 4, mean postoperative functional mitral regurgitation was 1.2+/-0.8 when preoperative MVCD was 10 mm or less and 2.5+/-0.7 when preoperative MVCD was 11 mm or higher (p < 0.05). Globally, functional results were not influenced by the strategy of treatment (MV repair or replacement).
Mitral valve operation can give satisfying survival and good palliation of dilated cardiomyopathy. The MVCD can be helpful in the choice of the surgical strategy on the MV.
二尖瓣（MV）手术治疗扩张型心肌病正逐渐普及。我们根据10年的经验分析了二尖瓣修复或置换的适应证。
1990年1月至2000年5月，49例扩张型心肌病患者（12例特发性，37例缺血性）接受了二尖瓣手术，29例行修复术，20例行置换术。术前评估包括测量二尖瓣对合深度（CD），以反映导致功能性二尖瓣反流的二尖瓣装置异常。
30天死亡率为4.2%（2例患者）。1年、3年、5年和10年的精算生存率分别为90%、87%、78%和73%。至少改善一个纽约心脏协会心功能分级的生存可能性分别为88%、76%、71%和65%。二尖瓣修复术后功能性二尖瓣反流几乎不可避免；然而，采用0至4级评分，术前二尖瓣CD为10mm或以下时，术后平均功能性二尖瓣反流为1.2±0.8，术前二尖瓣CD为11mm或更高时为2.5±0.7（p<0.05）。总体而言，功能结果不受治疗策略（二尖瓣修复或置换）的影响。
二尖瓣手术可使扩张型心肌病患者获得满意的生存率和良好的病情缓解。二尖瓣CD有助于选择二尖瓣手术策略。
