Akar A Ruchan, Doukas George, Szafranek Adam, Alexiou Christos, Boehm Maria C, Chin Derek, Sosnowski Andrzej, Spyt Tom J
Department of Cardiothoracic Surgery and Cardiology, University Hospitals of Leicester, UK.
J Heart Valve Dis. 2002 Nov;11(6):793-800; discussion 801.
Surgery for ischemic mitral regurgitation (IMR) is required in 4-5% of patients subjected to coronary artery surgery, and may be challenging. The study aim was to determine outcome following mitral valve repair and myocardial revascularization for moderate-to-severe IMR.
A total of 102 patients (mean age 68+/-7 years) underwent mitral valve repair for IMR between 1998 and 2001 at the authors' unit. Among patients, 28 had acute and 74 chronic mitral regurgitation (MR). Valve repair was achieved with an annuloplasty ring in all 102 patients, while 99 underwent concomitant myocardial revascularization. Preoperatively, 69 patients had MR grade III-IV, 62 had CCS angina class III-IV, 59 were in NYHA class II-IV, 81 had impaired left ventricular function, and 10 were in cardiogenic shock. Follow up was 100% complete (mean 14+/-7 months; range: 0-38 months).
Overall operative mortality was 8.8% (n = 9) (17.8% for acute IMR, 5.4% for chronic, p = 0.048). On multiple logistic regression analysis, cardiogenic shock (p = 0.028) was the only significant risk factor for operative death. There were 11 late deaths. Kaplan-Meier survival at one and three years was 82+/-4% and 79+/-4%, respectively. On Cox proportional hazards regression model, preoperative left ventricular end-systolic diameter (LVESD) >4.5 cm (p = 0.01) and NYHA class III-IV (p = 0.02) were independent adverse predictors of survival. Three patients required reoperation. Kaplan-Meier three-year freedom from reoperation was 97+/-2%.
Surgery for IMR carries a considerable, but acceptable, operative risk and provides satisfactory freedom from reoperation and mid-term survival. Cardiogenic shock before surgery is the major determinant of an unfavorable in-hospital outcome. LVESD >4.5 cm and poor preoperative NYHA status limit the probability of late survival. The study results support early surgical intervention for IMR, before ventricular dilatation occurs.
在接受冠状动脉手术的患者中，4% - 5% 需要进行缺血性二尖瓣反流（IMR）手术，且该手术可能具有挑战性。本研究的目的是确定中重度 IMR 患者二尖瓣修复及心肌血运重建后的结局。
1998 年至 2001 年期间，作者所在科室共有 102 例患者（平均年龄 68±7 岁）因 IMR 接受二尖瓣修复手术。其中，28 例为急性二尖瓣反流，74 例为慢性二尖瓣反流（MR）。所有 102 例患者均使用瓣环成形环进行瓣膜修复，99 例同时进行了心肌血运重建。术前，69 例患者的 MR 分级为 III - IV 级，62 例患者的加拿大心血管学会（CCS）心绞痛分级为 III - IV 级，59 例患者的纽约心脏协会（NYHA）心功能分级为 II - IV 级，81 例患者的左心室功能受损，10 例患者处于心源性休克状态。随访率达 100%（平均 14±7 个月；范围：0 - 38 个月）。
总体手术死亡率为 8.8%（n = 9）（急性 IMR 为 17.8%，慢性为 5.4%，p = 0.048）。多因素逻辑回归分析显示，心源性休克（p = 0.028）是手术死亡的唯一显著危险因素。有 11 例晚期死亡。1 年和 3 年的 Kaplan - Meier 生存率分别为 82±4%和 79±4%。在 Cox 比例风险回归模型中，术前左心室收缩末期内径（LVESD）>4.5 cm（p = 0.01）和 NYHA 分级 III - IV 级（p = 0.02）是生存的独立不良预测因素。3 例患者需要再次手术。Kaplan - Meier 三年无再次手术率为
