Rothenburger M, Rukosujew A, Hammel D, Dorenkamp A, Schmidt C, Schmid C, Wichter T, Scheld H H
Department of Thoracic and Cardiovascular Surgery, University Hospital Muenster, Germany.
Thorac Cardiovasc Surg. 2002 Dec;50(6):351-4. doi: 10.1055/s-2002-35746.
Mitral valve surgery for the correction of secondary mitral valve regurgitation (MR) in cardiomyopathy is associated with a poor outcome. Numerous studies have identified a severe left ventricular dysfunction as an indicator for a poor prognosis. The aim of the study was to asses the follow-up after mitral valve surgery and severe left ventricular dysfunction.
Between 1994 and 2000, 31 patients with mitral regurgitation and a left ventricular ejection fraction of below thirty percent undergoing isolated repair (n = 16) or replacement (n = 15) were investigated. All patients received maximal drug therapy. Twenty-one patients were New York Heart Association (NYHA) class III and 10 were class IV. Follow-up with echocardiography, ECG, and chest x-ray was performed in 87 % of the survivors. The mean duration of follow-up was 39 +/- 16 months.
The mean duration of ICU and hospital stay was 3.6 +/- 2.1 days and 8.1 +/- 5.4 days, respectively. The 1-, 2-, and 5-year survival rates were 91 %, 84 %, and 77 %, respectively. NYHA class improved from 3.3 +/- 0.8 to 2.1 +/- 0.7 at follow-up (p < 0.01). The ejection fraction improved from 23.1 +/- 6.6 % to 36 +/- 6.8 % at follow-up (p < 0.02). Freedom from readmission for heart failure was 85 %, 79 %, and 68 % at 1-, 2-, and 5 years, respectively.
Mitral valve surgery improves left ventricular function and reduces heart failure severity in patients with MR and cardiomyopathy. High-risk mitral valve surgery may be an alternative to heart transplantation in selected patients.
心肌病患者因继发性二尖瓣反流（MR）行二尖瓣手术的预后较差。大量研究已确定严重左心室功能障碍是预后不良的指标。本研究的目的是评估二尖瓣手术后及严重左心室功能障碍的随访情况。
1994年至2000年间，对31例二尖瓣反流且左心室射血分数低于30%的患者进行了研究，其中16例行单纯修复术，15例行置换术。所有患者均接受了最大程度的药物治疗。21例患者为纽约心脏协会（NYHA）心功能Ⅲ级，10例为Ⅳ级。87%的幸存者接受了超声心动图、心电图和胸部X线随访。平均随访时间为39±16个月。
重症监护病房（ICU）平均住院时间和住院时间分别为3.6±2.1天和8.1±5.4天。1年、2年和5年生存率分别为91%、84%和77%。随访时NYHA心功能分级从3.3±0.8改善至2.1±0.7（p<0.01）。随访时射血分数从23.1±6.6%提高至36±6.8%（p<0.02）。1年、2年和5年无心力衰竭再入院率分别为85%、79%和68%。
二尖瓣手术可改善MR和心肌病患者的左心室功能，减轻心力衰竭严重程度。对于特定患者，高风险二尖瓣手术可能是心脏移植的替代选择。
