慢性缺血性二尖瓣反流的二尖瓣手术

Mitral valve surgery for chronic ischemic mitral regurgitation.

作者信息

Calafiore Antonio M, Di Mauro Michele, Gallina Sabina, Di Giammarco Gabriele, Iacò Angela L, Teodori Giovanni, Tavarozzi Isabella

机构信息

Division of Cardiac Surgery, University Hospital, Torino, Italy.

出版信息

Ann Thorac Surg. 2004 Jun;77(6):1989-97. doi: 10.1016/j.athoracsur.2003.11.017.

DOI:10.1016/j.athoracsur.2003.11.017

PMID:15172252

Abstract

BACKGROUND

Early and midterm clinical and echocardiographic results after mitral valve (MV) surgery for chronic ischemic mitral regurgitation were investigated to evaluate the validity of the criteria for repair or replacement applied by us.

METHODS

From 1988 to 2002, 102 patients with ischemic mitral regurgitation underwent MV surgery (82 repairs and 20 replacements). End-systolic distance between the coaptation point of mitral leaflets and the plane of mitral annulus was the key factor that allowed either repair (<or=10 mm) or replacement (>10 mm). Patients who had MV replacement showed higher New York Heart Association class (3.2 +/- 0.5 versus 3.4 +/- 0.5; p = 0.016), lower preoperative ejection fraction (0.33 +/- 0.9 versus 0.38 +/- 0.12; p = 0.034), and higher end-diastolic volume (161 +/- 69 mL versus 109 +/- 35 mL; p < 0.001) compared with repair. Mitral regurgitation was 3.2 +/- 0.7 in both groups.

RESULTS

Thirty-day mortality was 3.9% (2.4% MV repair versus 10.0% MV replacement; not significant). During the follow-up 26 patients died. Of the 72 survivors, 55 (76.3%) were in New York Heart Association classes I and II. Five-year survival was 75.6% +/- 4.7% in MV repair and 66.0% +/- 10.5% in MV replacement (not significant). Survival in New York Heart Association classes I and II was 58.9% +/- 5.4% in MV repair and 40.0% +/- 11.0% in MV replacement (not significant). Cox analysis identified preoperative New York Heart Association class, ejection fraction, end-diastolic volume, end-systolic volume, and congestive heart failure as risk factors common to both events. In 46 patients, late echocardiograms showed no volume or ejection fraction modifications. In patients who underwent MV repair, 50% had no or mild mitral regurgitation.

CONCLUSIONS

Correction of chronic ischemic mitral regurgitation through either repair or replacement provides a good 5-year survival rate, with more than 75% of the survivors in New York Heart Association classes I and II.

摘要

背景

对慢性缺血性二尖瓣反流患者行二尖瓣（MV）手术后的早期和中期临床及超声心动图结果进行研究，以评估我们所采用的修复或置换标准的有效性。

方法

1988年至2002年，102例缺血性二尖瓣反流患者接受了MV手术（82例修复，20例置换）。二尖瓣叶瓣叶贴合点与二尖瓣环平面之间的收缩末期距离是决定行修复（≤10 mm）或置换（>10 mm）的关键因素。接受MV置换的患者与接受修复的患者相比，纽约心脏协会分级更高（3.2±0.5对3.4±0.5；p = 0.016），术前射血分数更低（0.33±0.9对0.38±0.12；p = 0.034），舒张末期容积更高（161±69 mL对109±35 mL；p < 0.001）。两组的二尖瓣反流程度均为3.2±0.7。

结果

30天死亡率为3.9%（MV修复组为2.4%，MV置换组为10.0%；无显著性差异）。随访期间有26例患者死亡。在72例幸存者中，55例（76.3%）纽约心脏协会分级为I级和II级。MV修复组的5年生存率为75.6%±4.7%，MV置换组为66.0%±10.5%（无显著性差异）。纽约心脏协会分级为I级和II级患者的生存率，MV修复组为58.9%±5.4%，MV置换组为40.0%±11.0%（无显著性差异）。Cox分析确定术前纽约心脏协会分级、射血分数、舒张末期容积、收缩末期容积和充血性心力衰竭是这两种情况共有的危险因素。46例患者的晚期超声心动图显示容积或射血分数无变化。在接受MV修复的患者中，50%无或仅有轻度二尖瓣反流。