Heikkinen Jouni, Biancari Fausto, Uusimaa Paavo, Satta Jari, Juvonen Jukka, Ylitalo Kari, Niemelä Matti, Salmela Esa, Juvonen Tatu, Lepojärvi Martti
Division of Cardiothoracic and Vascular Surgery, Department of Surgery, Oulu University Hospital, Oulu, Finland.
Scand Cardiovasc J. 2005 Sep;39(4):229-36. doi: 10.1080/14017430510035853.
Several studies reported excellent long-term results after mitral valve repair for regurgitation, however a number of patients still experience recurrent mitral valve regurgitation which requires reoperation. We have evaluated the long-term outcome of a consecutive series of patients who underwent mitral valve repair for regurgitation in an attempt to identify the risk factors associated with late failures.
One-hundred and sixty-four patients underwent mitral valve repair for ischemic and degenerative mitral valve regurgitation. Seventy-two patients underwent echocardiographic evaluation a median of 5.6 years after surgery.
Ten-year survival freedom from any fatal cardiac event was 75.9% and survival freedom from redo mitral valve surgery was 93.8%. Multivariable analysis showed that residual mitral valve regurgitation grade>1 as assessed during the immediate postoperative period (at 10-year, 60.6% vs. 95.7%, p=0.001, RR 20.7, 95%C.I. 3.4-125.3) and chronic obstructive pulmonary disease/asthma (at 10-year 66.8% vs. 95.2%, p=0.013, RR 12.0, 95%C.I. 1.7-85.2) were predictors of redo mitral valve surgery. The same findings were observed also among patients with myxomatous degenerative disease. At echocardiographic follow-up, no significant improvement was detected in terms of left ventricular ejection fraction, whilst mitral valve regurgitation grade (median, 3 to 1), New York Heart Association class (median, 2 to 1) and left atrium diameter (median, 50 to 44 mm) decreased significantly.
This study confirms the excellent clinical long-term results after mitral valve repair. An adequate repair technique is advocated in order to decrease the immediate postoperative rate of residual regurgitation>1 as this is a main determinant of late failures requiring redo mitral valve surgery. Further studies are required to better define the possible causative role of chronic obstructive pulmonary disease and any underlying connective tissue metabolic disorder in late failures after mitral valve repair.
多项研究报告了二尖瓣反流修复术后出色的长期效果，然而仍有一些患者出现复发性二尖瓣反流，需要再次手术。我们评估了一系列连续接受二尖瓣反流修复术患者的长期结局，以试图确定与晚期失败相关的危险因素。
164例患者因缺血性和退行性二尖瓣反流接受二尖瓣修复术。72例患者在术后中位时间5.6年接受了超声心动图评估。
10年无任何致命心脏事件的生存率为75.9%，无需再次二尖瓣手术的生存率为93.8%。多变量分析显示，术后即刻评估的残余二尖瓣反流分级>1（10年时，60.6%对95.7%，p=0.001，RR 20.7，95%置信区间3.4-125.3）以及慢性阻塞性肺疾病/哮喘（10年时66.8%对95.2%，p=0.013，RR 12.0，95%置信区间1.7-85.2）是再次二尖瓣手术的预测因素。在黏液瘤样退行性疾病患者中也观察到了相同的结果。在超声心动图随访中，左心室射血分数方面未检测到显著改善，而二尖瓣反流分级（中位数，从3降至1）、纽约心脏协会心功能分级（中位数，从2降至1）和左心房直径（中位数，从50降至44mm）均显著降低。
本研究证实了二尖瓣修复术后出色的临床长期效果。提倡采用适当的修复技术以降低术后即刻残余反流分级>1的发生率，因为这是需要再次二尖瓣手术的晚期失败的主要决定因素。需要进一步研究以更好地确定慢性阻塞性肺疾病以及任何潜在的结缔组织代谢紊乱在二尖瓣修复术后晚期失败中可能的致病作用。
