Akins Cary W, Bitondo Jerene M, Hilgenberg Alan D, Vlahakes Gus J, Madsen Joren C, MacGillivray Thomas E
Department of Surgery, White 503, Massachusetts General Hospital, 55 Fruit Street, Boston, MA 02114, USA.
J Heart Valve Dis. 2005 Nov;14(6):792-9; discussion 799-800.
Although the incidence of paravalular leaks, the most common cause of non-structural dysfunction after valve replacement, is well defined, the results of their surgical correction are not. Given the growing enthusiasm for interventional catheter-based correction of paravalvular leaks, a current surgical baseline against which to compare these results is important.
All patients who had surgical correction of an aortic or mitral paravalvular leak unrelated to acute bacterial endocarditis between 1986 and 2001 were identified from a computerized registry. Hospital records were reviewed, and follow up data obtained.
A total of 136 consecutive patients (73 males, 63 females; mean age 64 years) underwent surgical correction of a paravalvular leak. Of the valves, 44 (32%) were aortic and 92 (68%) mitral. More than one previous cardiac operation had been performed in 68 patients (50%). In 107 patients (79%; 32 aortic (73%), 75 mitral (82%)), the leak was the primary indication for reoperation, while for 29 patients (21%; 12 aortic (27%), 17 mitral (18%)) the correction was secondary to another cardiac procedure. In 65 patients (48%; 12 aortic (27%), 53 (58%) mitral)) the leak was repaired primarily, while in 71 patients (52%; 32 aortic (73%), 39 (42%) mitral)) the prosthesis was replaced. Operative mortality was 6.6% (n = 9). There were no significant multivariable predictors of hospital death. Perioperative stroke occurred in seven cases (5.1%), and hospital stay was >14 days in 40 patients (29%). The 10-year Kaplan-Meier survival was 30 (CI 20-39)%. Ten-year actual versus actuarial freedom from repeat paravalvular leak was 84 (CI 68-92)% versus 63 (CI 49-76)%.
Surgical correction of cardiac paravalvular leaks can be performed with acceptable mortality and morbidity. Patients with surgically corrected paravalvular leaks have a limited life expectancy, but reasonable freedom from recurrent paravalvular leak.
尽管瓣周漏（瓣膜置换术后非结构性功能障碍最常见的原因）的发生率已明确，但手术矫正的结果尚不明确。鉴于基于介入导管的瓣周漏矫正方法越来越受到关注，建立一个当前的手术基线以比较这些结果很重要。
从计算机登记系统中识别出1986年至2001年间接受主动脉瓣或二尖瓣瓣周漏手术矫正且与急性细菌性心内膜炎无关的所有患者。回顾医院记录并获取随访数据。
共有136例连续患者（73例男性，63例女性；平均年龄64岁）接受了瓣周漏手术矫正。其中44个（32%）瓣膜为主动脉瓣，92个（68%）为二尖瓣。68例患者（50%）曾接受过一次以上心脏手术。107例患者（79%；32例主动脉瓣（73%），75例二尖瓣（82%））中，瓣周漏是再次手术的主要指征，而29例患者（21%；12例主动脉瓣（27%），17例二尖瓣（18%））的矫正手术是在另一次心脏手术之后进行的。65例患者（48%；12例主动脉瓣（27%），53例二尖瓣（58%））主要修复了瓣周漏，而71例患者（52%；32例主动脉瓣（73%），39例二尖瓣（42%））更换了人工瓣膜。手术死亡率为6.6%（n = 9）。没有显著的多变量因素可预测医院死亡。围手术期发生中风7例（5.1%），40例患者（29%）住院时间>14天。10年Kaplan-Meier生存率为30%（可信区间20 - 39%）。实际10年与预期10年无瓣周漏复发的比例分别为84%（可信区间68 - 92%）和63%（可信区间49 - 76%）。
心脏瓣周漏的手术矫正可在可接受的死亡率和发病率下进行。接受手术矫正的瓣周漏患者预期寿命有限，但瓣周漏复发的可能性较小。
