Feindel Christopher M, Tufail Zafar, David Tirone E, Ivanov Joan, Armstrong Susan
Division of Cardiovascular Surgery, Peter Munk Cardiac Centre, Toronto General Hospital and the University of Toronto, 200 Elizabeth Street--14EN-205, Toronto, Ontario, Canada M5G 2C4.
J Thorac Cardiovasc Surg. 2003 Sep;126(3):777-82. doi: 10.1016/s0022-5223(03)00081-3.
The objective of this work was to examine the clinical outcomes of mitral valve surgery in patients with extensive mitral annular calcification.
Mitral valve surgery was performed in 54 patients (28 men and 26 women, mean age 63 +/- 14 years) with mitral regurgitation and extensive mitral annular calcification. Most patients (78%) were in New York Heart Association classes III and IV, 14 had coronary artery disease, and 9 had prior mitral valve replacement in which the calcium bar was not removed. The calcium bar was excised and a new mitral annulus was created by suturing a strip of pericardium onto the endocardium of the left ventricle from lateral to medial fibrous trigones and to the endocardium of the left atrium. The mitral valve was repaired in 12 patients and replaced in 42. In 23 patients the intervalvular fibrous body was reconstructed and the aortic valve was also replaced. Mean follow-up was 4.1 +/- 3.7 years and was complete.
There were 5 operative deaths and 11 late deaths. Five-year survival was 73 +/- 7%. Four patients needed reoperation and each survived. Freedom from reoperation at 5 years was 89 +/- 6%. Three patients had a stroke and 4 had anticoagulation-related hemorrhage, one of which was fatal. Five-year freedom from valve-related mortality or morbidity was 75 +/- 8%. Most survivors were in New York Heart Association functional classes II and III.
Resection of the calcium bar and creation of a new annulus with pericardium provided good clinical results in patients with extensive calcification of the mitral valve.
本研究旨在探讨广泛二尖瓣环钙化患者二尖瓣手术的临床结局。
对54例（28例男性，26例女性，平均年龄63±14岁）二尖瓣反流合并广泛二尖瓣环钙化患者进行二尖瓣手术。大多数患者（78%）为纽约心脏协会III级和IV级，14例有冠状动脉疾病，9例曾行二尖瓣置换术但未去除钙化条。切除钙化条，通过将一条心包条从外侧至内侧纤维三角缝合到左心室心内膜和左心房心内膜上，创建一个新的二尖瓣环。12例患者行二尖瓣修复，42例患者行二尖瓣置换。23例患者重建瓣间纤维体并同时置换主动脉瓣。平均随访4.1±3.7年，随访完整。
有5例手术死亡和11例晚期死亡。5年生存率为73±7%。4例患者需要再次手术，均存活。5年无再次手术率为89±6%。3例患者发生卒中，4例发生抗凝相关出血，其中1例死亡。5年无瓣膜相关死亡率或发病率为75±8%。大多数幸存者为纽约心脏协会功能II级和III级。
切除钙化条并用心包创建新的瓣环，为广泛二尖瓣钙化患者提供了良好的临床效果。
