Harris Kevin M, Reddy Avinash, Aepplii Dorothee, Wilson Betsy, Emery Robert W
The Minneapolis Heart Institute Foundation, Minneapolis, Minnesota, USA.
Heart Surg Forum. 2005;8(2):E89-93. doi: 10.1532/HSF98.20041162.
Patients undergoing on-pump coronary artery bypass surgery (CAB) with coexistent moderate ischemic mitral regurgitation (IMR) have a significant mortality rate compared to patients without MR. The mortality rate is elevated both perioperatively (0%-12% mortality), as well as over a 1- and 2-year postoperative period (15%-25%). It is thought that some patients are best served by off-pump CAB (OPCAB); however, outcomes have not been reported for such patients with coexistent moderate IMR.
We reviewed the independent database of patients undergoing OPCAB between 1995 and 2002 to find 989 patients, 17 (1.7%) of whom had moderate or moderately severe MR. Patients were contacted and clinical and echocardiographic data were obtained.
The patient group consisted of 11 men and 6 women (age, 65 +/- 15 years). The study group had a PA pressure of 52 +/- 14, creatinine of 1.6 +/- 0.7, and left ventricular ejection fraction of 43 +/- 18. Nine patients (53%) had advanced New York Heart Association (class III-IV) heart failure. Mortality rates perioperatively and at 1, 2, and 3 years were 0%, 6.25% (1/16), 12.5% (2/16), and 38% (4/8), respectively. At the time of this report, no patient had returned for a reparative procedure.
In patients felt to be best served by OPCAB with ischemic MR, operative and intermediate mortality rates are remarkably similar to those previously reported for on-pump series. These data underscore the continued need to understand which patients undergoing CAB require mitral valve problems to be addressed at the time of surgery.
与无二尖瓣反流（MR）的患者相比，接受体外循环冠状动脉搭桥手术（CAB）且并存中度缺血性二尖瓣反流（IMR）的患者死亡率显著升高。围手术期死亡率（0%-12%）以及术后1年和2年的死亡率（15%-25%）均有所升高。有人认为，一些患者采用非体外循环CAB（OPCAB）治疗效果最佳；然而，尚未有关于此类并存中度IMR患者治疗结果的报道。
我们回顾了1995年至2002年间接受OPCAB患者的独立数据库，共找到989例患者，其中17例（1.7%）患有中度或中度以上MR。我们联系了这些患者并获取了临床和超声心动图数据。
患者组包括11名男性和6名女性（年龄65±15岁）。研究组的肺动脉压为52±14，肌酐为1.6±0.7，左心室射血分数为43±18。9例患者（53%）患有纽约心脏协会（III-IV级）晚期心力衰竭。围手术期、术后1年、2年和3年的死亡率分别为0%、6.25%（1/16）、12.5%（2/16）和38%（4/8）。在撰写本报告时，尚无患者因修复手术而复诊。
对于被认为采用OPCAB治疗缺血性MR效果最佳的患者，手术死亡率和中期死亡率与先前报道的体外循环手术系列结果非常相似。这些数据强调了持续需要了解哪些接受CAB手术的患者需要在手术时解决二尖瓣问题。
