Hsu Chiao-Po, Chang Shiao-Hwang, Yung Ming-Chi, Wang Jih-Shiuan, Shih Chun-Che, Hwang Cheng-Hsiung, Weng Zen-Chung, Yu Tarng-Jenn, Lai Shiau-Ting
Division of Cardiovascular Surgery, Department of Surgery, National Yang-Ming University, Veterans General Hospital--Taipei, 201 Sec. 2, Shih-Pai Road, Taipei 112, Taiwan.
Heart Vessels. 2004 Jan;19(1):27-32. doi: 10.1007/s00380-003-0728-6.
The advantages of mitral valve repair in mitral regurgitation are well established. The aim of this study was to analyze retrospectively the early and mid-term results of primary mitral valve repair. Between January 1995 and August 2001, primary mitral valve repair operations were performed on 112 patients (76 men and 36 women) with mitral regurgitation; the mean age was 59.8 +/- 16.5 years. Mitral valve repair was performed for rheumatic heart disease (13), degenerative disease (60), infective endocarditis (2), ischemic heart disease (26), congenital heart disease (2), and dilated cardiomyopathy (9). The degree of mitral regurgitation was moderate in 28 patients, moderately severe in 17 patients, and severe in 67 patients, as determined by echocardiography. Left ventricular ejection fraction (mean 41.2% +/- 13.5%) was measured by radionuclide ventriculography. Fifty percent of patients underwent additional procedures (e.g., coronary artery bypass grafting). The mortality rate was 8.9% (10/112) for hospitalized patients, 19.2% (5/26) for ischemic disease, and 5% (3/60) for degenerative disease. Follow-up duration ranged from 0.37 to 84.03 months. All survivors were evaluated with serial echocardiography. At the final follow-up echocardiography of 94 patients without reoperation and 6 patients at the time of reoperation, 84% had no or mild mitral regurgitation. The survival rate at 5 years was 92.68 +/- 3.57% for degenerative disease and 44.47% +/- 10.89% for ischemic disease. The risk of infective endocarditis (1.78%), thromboembolism (1.78%), and anticoagulant-related complications (0.8%) was very low during the follow-up period. The pathophysiological mechanism resulting in mitral regurgitation was the most important determinant of outcome after mitral valve repair. Excellent results were achieved with mitral valve repair for degenerative disease. Because of low morbidity and acceptable mortality, we strongly recommend mitral valve repair for mitral regurgitation due to degenerative disease.
二尖瓣反流患者行二尖瓣修复术的优势已得到充分证实。本研究旨在回顾性分析初次二尖瓣修复术的早期和中期结果。1995年1月至2001年8月期间，对112例二尖瓣反流患者（76例男性和36例女性）进行了初次二尖瓣修复手术；平均年龄为59.8±16.5岁。二尖瓣修复术的病因包括风湿性心脏病（13例）、退行性疾病（60例）、感染性心内膜炎（2例）、缺血性心脏病（26例）、先天性心脏病（2例）和扩张型心肌病（9例）。经超声心动图检查确定，28例患者二尖瓣反流程度为中度，17例为中重度，67例为重度。通过放射性核素心室造影测量左心室射血分数（平均41.2%±13.5%）。50%的患者接受了额外的手术（如冠状动脉旁路移植术）。住院患者的死亡率为8.9%（10/112），缺血性疾病患者为19.2%（5/26），退行性疾病患者为5%（3/60）。随访时间为0.37至84.03个月。所有幸存者均接受了系列超声心动图检查。在94例未再次手术患者的末次随访超声心动图检查以及6例再次手术时患者的检查中，84%的患者无二尖瓣反流或仅有轻度二尖瓣反流。退行性疾病患者5年生存率为92.68±3.57%，缺血性疾病患者为44.47%±10.89%。随访期间感染性心内膜炎（1.78%）、血栓栓塞（1.78%）和抗凝相关并发症（0.8%）的风险非常低。导致二尖瓣反流的病理生理机制是二尖瓣修复术后预后的最重要决定因素。退行性疾病行二尖瓣修复术取得了优异的效果。由于发病率低且死亡率可接受，我们强烈推荐对退行性疾病导致的二尖瓣反流行二尖瓣修复术。
