与“初发性”二尖瓣狭窄患者相比，外科二尖瓣交界切开术后再狭窄患者经皮气囊二尖瓣交界切开术的远期结果

Late results of percutaneous balloon mitral commissurotomy in patients with restenosis after surgical commissurotomy compared to patients with 'de-novo' stenosis.

作者信息

Chmielak Zbigniew, Ruzyllo Witold, Demkow Marcin, Soroka Magdalena, Karcz Maciej, Konka Marek, Bekta Pawel, Kepka Cezary

机构信息

Department of General Cardiology, National Institute of Cardiology, Warsaw, Poland.

出版信息

J Heart Valve Dis. 2002 Jul;11(4):509-16.

PMID:12150299

Abstract

BACKGROUND AND AIMS OF THE STUDY

The outcome of percutaneous balloon mitral commissurotomy (BMC) has been reported as poor in patients with prior surgical commissurotomy. The study aim was to evaluate immediate and long-term follow up results of BMC in patients with restenosis after surgical commissurotomy compared to patients with 'de-novo' mitral stenosis.

METHODS

Between October 1988 and September 1999, a total of 1,027 patients underwent BMC. Of these patients, 169 (16.5%) were examined at 17+/-7 years (range: 2-33 years) after surgical commissurotomy (group 1), and 858 (83.5%) had de-novo mitral stenosis (group 2).

RESULTS

Group 1 patients were older than group 2 patients (49.4+/-9.3 versus 47.3+/-9.6 years; p <0.05), and atrial fibrillation was seen more often in group 1 (53.9% versus 32.4%; p <0.005). Before BMC, mitral valve area (MVA) was similar in both groups (1.18+/-0.27 and 1.15+/-0.26 cm2 in groups 1 and 2 respectively; p = NS); following BMC, MVA was 1.82+/-0.3 and 1.93+/-0.40 cm2 respectively (p <0.05). Four patients (2.4%) from group 1, and 24 (2.8%) from group 2 required mitral valve replacement due to severe regurgitation (p = NS). Annual clinical and echocardiographic evaluation was completed for 950 patients (mean follow up 56.2+/-31.1 months (range: 12-132 months). Cardiac events defined as death, valve surgery or repeat BMC occurred in 16.0% of patients in group 1, and in 9.6% of those in group 2. At follow up of three, five and 10 years, actuarial event-free survival was 85.7+/-2.9%, 79.8+/-3.8% and 65.2+/-7.5% respectively in group 1, and 93.4+/-0.9%, 90.1+/-1.1% and 72.7+/-3.9% respectively in group 2 (log rank test, p = 0.02). Multivariate analysis showed MVA <1.5 cm2 after BMC, mitral regurgitation grade >2/4, Wilkins score >8, and mean transmitral gradient and left atrial mean pressure post BMC to be independent predictors of an adverse event occurring during follow up.

CONCLUSION

BMC in patients with restenosis after surgical commissurotomy is an effective method of treatment, and may help to avoid valve surgery in most patients.

摘要

研究背景与目的

据报道，既往接受过二尖瓣手术切开术的患者经皮二尖瓣球囊成形术（BMC）效果不佳。本研究旨在评估手术二尖瓣切开术后再狭窄患者与“初发”二尖瓣狭窄患者接受BMC的近期及长期随访结果。

方法

1988年10月至1999年9月期间，共有1027例患者接受了BMC。其中，169例（16.5%）在手术二尖瓣切开术后17±7年（范围：2 - 33年）接受检查（第1组），858例（83.5%）为初发二尖瓣狭窄患者（第2组）。

结果

第1组患者比第2组患者年龄更大（49.4±9.3岁对47.3±9.6岁；p<0.05），第1组中房颤更为常见（53.9%对32.4%；p<0.005）。在BMC前，两组的二尖瓣瓣口面积（MVA）相似（第1组和第2组分别为1.18±0.27和1.15±0.26 cm²；p =无显著差异）；BMC后，MVA分别为1.82±0.3和1.93±0.40 cm²（p<0.05）。第1组有4例患者（2.4%），第2组有24例患者（2.8%）因严重反流需要进行二尖瓣置换（p =无显著差异）。对950例患者进行了年度临床和超声心动图评估（平均随访56.2±31.1个月（范围：12 - 132个月））。定义为死亡、瓣膜手术或再次BMC的心脏事件在第1组患者中发生率为16.0%，在第2组患者中发生率为9.6%。在3年、5年和10年随访时，第1组的无事件生存率分别为85.7±2.9%、79.8±3.8%和65.2±7.5%，第2组分别为93.4±0.9%、90.1±1.1%和72.7±3.9%（对数秩检验，p = 0.02）。多因素分析显示，BMC后MVA<1.5 cm²、二尖瓣反流分级>2/4、威尔金斯评分>8以及BMC后的平均跨二尖瓣压差和左心房平均压是随访期间不良事件发生的独立预测因素。