Yamaguchi Atsushi, Kawahito Koji, Adachi Hideo, Ino Takashi
Department of Cardiovascular Surgery, Jichi Medical School, Omiya Medical Center, Saitama, Japan.
Jpn J Thorac Cardiovasc Surg. 2003 Sep;51(9):407-12. doi: 10.1007/BF02719592.
Mitral valve surgery for the correction of mitral regurgitation (MR) in patients with ischemic heart disease has been associated with poor prognosis. The criteria for selecting an appropriate surgical procedure are not clearly defined. The objectives of this study were to clarify the criteria for mitral valve manipulation and the outcome in patients with ischemic MR.
Twenty patients with ischemic MR were proposed for surgery. Ten of them (group A) had grade II MR and underwent isolated coronary artery bypass grafting (CABG). The remaining 10 patients with grade III or more MR underwent both CABG and mitral valve repair (group B). Postoperative left ventricular function and outcome were compared.
Preoperative left ventricular end-systolic volume index (LVESVI) in group A was significantly smaller, while preoperative ejection fraction (EF) was almost equal between the groups. EF demonstrated a significant improvement in group A postoperatively, but no changes in group B. Two of group B died following surgery. The other patients were successfully treated with surgery which diminished MR. Congestive heart failure (CHF) developed in 2 patients of group B during follow-up and in none of group A. The 5-year freedom from CHF and the 5-year survival rate in group A were significantly greater than those in group B.
Deterioration of mitral valve function, which necessitated mitral valve repair, was more frequent in the impaired and enlarged hearts. Although mitral repair was beneficial for diminishing MR and New York Heart Association, postoperative course in patients with ischemic MR depended on the preoperative LVESVI.
缺血性心脏病患者二尖瓣反流（MR）的二尖瓣手术预后较差。选择合适手术方式的标准尚不明确。本研究的目的是明确缺血性MR患者二尖瓣手术操作的标准及预后情况。
20例缺血性MR患者拟行手术治疗。其中10例（A组）为II级MR，接受单纯冠状动脉旁路移植术（CABG）。其余10例III级及以上MR患者接受CABG及二尖瓣修复术（B组）。比较术后左心室功能及预后情况。
A组术前左心室收缩末期容积指数（LVESVI）显著较小，而两组术前射血分数（EF）几乎相等。A组术后EF显著改善，而B组无变化。B组有2例术后死亡。其他患者手术成功，MR减轻。随访期间，B组有2例发生充血性心力衰竭（CHF），A组无。A组5年无CHF生存率及5年生存率显著高于B组。
二尖瓣功能恶化（需行二尖瓣修复术）在受损及扩大的心脏中更为常见。虽然二尖瓣修复有利于减轻MR及纽约心脏协会分级，但缺血性MR患者的术后病程取决于术前LVESVI。
