Vidal V, Langanay T, Lelong B, el Issa A, Pony J C, Daubert J C, Almange C, Leguerrier A, Rioux C, Logeais Y
Clinique chirurgicale cardiovasculaire et thoracique, hôpital de Pontchaillou, Rennes.
Arch Mal Coeur Vaiss. 1992 Feb;85(2):169-74.
A total of 790 patients underwent isolated (N = 520) or mitral valve replacement associated with a tricuspid valve procedure for lesions excluding post-myocardial infarction mitral regurgitation. The mean age was 54 years: the sex ratio was 1.9 +/- 1.1, female/male. Three hundred and four patients (38.5%) were in the NYHA functional class II and 406 patients (61.5%) were in classes III or IV. The operative mortality was 9.7% (77 patients). The factors associated with a high operative risk were, on multifactorial analysis: double valve replacement, age over 70 years, NYHA class IV, aortic clamp time over 68 minutes and the presence of mitral regurgitation. Seven hundred and four of the 713 survivors were contacted (98.7% follow-up). The average follow-up period was 5.05 years (range 11 to 219 months) giving a total of 3,997 patient-years. The 5 and 10 year actuarial survival rates were 74.7% and 64.7% respectively. The presence of a tricuspid lesion requiring surgical correction, a high NYHA classification and the presence of mitral regurgitation were poor prognostic factors of long-term survival. Three hundred and sixteen of the 533 survivors at the time of the inquiry were in NYHA class I (59.3%), 188 in NYHA class II (35.3%) and 29 in NYHA class III or IV (5.4%). Mitral valve replacement should be considered early as the immediate and long-term results are closely related to the preoperative myocardial function.
共有790例患者接受了单纯二尖瓣置换术（n = 520）或二尖瓣置换术联合三尖瓣手术，病变不包括心肌梗死后二尖瓣反流。平均年龄为54岁，男女比例为1.9±1.1（女性/男性）。304例患者（38.5%）属于纽约心脏协会（NYHA）心功能II级，406例患者（61.5%）属于III级或IV级。手术死亡率为9.7%（77例患者）。多因素分析显示，与高手术风险相关的因素包括：双瓣置换术、年龄超过70岁、NYHA IV级、主动脉阻断时间超过68分钟以及存在二尖瓣反流。在713名幸存者中，有704人被随访（随访率98.7%）。平均随访期为5.05年（范围11至219个月），总计3997患者年。5年和10年的精算生存率分别为74.7%和64.7%。需要手术矫正的三尖瓣病变、NYHA分级高以及存在二尖瓣反流是长期生存的不良预后因素。在调查时，533名幸存者中有316人属于NYHA I级（59.3%），188人属于NYHA II级（35.3%），29人属于NYHA III级或IV级（5.4%）。应尽早考虑二尖瓣置换术，因为近期和远期结果与术前心肌功能密切相关。
