Kishon Y, Oh J K, Schaff H V, Mullany C J, Tajik A J, Gersh B J
Division of Cardiovascular Diseases, Mayo Clinic, Rochester, MN 55905.
Mayo Clin Proc. 1992 Nov;67(11):1023-30. doi: 10.1016/s0025-6196(12)61116-1.
The long-term clinical outcome was assessed in 22 patients (15 men and 7 women; mean age, 68 years) who underwent mitral valve replacement or repair for acute mitral regurgitation due to postinfarction rupture of a papillary muscle during the period 1981 through 1990 at the Mayo Clinic. All but three patients underwent operation within the first 3 weeks after acute myocardial infarction. The perioperative mortality was 27%, and the estimated actuarial survival rate at 7 years postoperatively was 47% and 64% for the entire group and for the patients who survived the operation, respectively. The concomitant performance of a coronary artery bypass grafting procedure was the only factor identified that improved both immediate and long-term survival. Patients with a decreased preoperative left ventricular ejection fraction (less than 45%) had somewhat greater short-term and long-term mortality than did those with a left ventricular ejection fraction of 45% or more, but the difference was only of borderline statistical significance. Other factors such as age, sex, severity of coronary artery disease, preoperative existence of congestive heart failure, and timing of the operation in relationship to occurrence of the infarction had no effect on survival. Of the 13 long-term survivors, 10 had significant clinical improvement in comparison with their preoperative state.
1981年至1990年期间，在梅奥诊所对22例因乳头肌梗死后破裂导致急性二尖瓣反流而接受二尖瓣置换或修复手术的患者（15例男性和7例女性；平均年龄68岁）进行了长期临床结局评估。除3例患者外，所有患者均在急性心肌梗死后的前三周内接受了手术。围手术期死亡率为27%，术后7年整个组和手术存活患者的预计精算生存率分别为47%和64%。唯一被确定能改善近期和长期生存的因素是同期进行冠状动脉旁路移植术。术前左心室射血分数降低（低于45%）的患者短期和长期死亡率略高于左心室射血分数为45%或更高的患者，但差异仅具有临界统计学意义。年龄、性别、冠状动脉疾病严重程度、术前存在充血性心力衰竭以及手术时间与梗死发生的关系等其他因素对生存无影响。在13例长期存活者中，10例与术前状态相比有显著的临床改善。
