Campwala Saida Zen, Bansal Ramesh C, Wang Nan, Razzouk Anees, Pai Ramdas G
Division of Cardiology, Loma Linda University Medical Center, Loma Linda, CA 90033, USA.
Eur J Cardiothorac Surg. 2006 Mar;29(3):348-53. doi: 10.1016/j.ejcts.2005.12.007. Epub 2006 Jan 24.
Though de novo mitral regurgitation (MR) is frequently seen in patients who have undergone coronary artery bypass surgery (CABG), its incidence, predictors, and mechanisms are not known.
Our surgical registry was screened for patients undergoing isolated CABG who had preoperative and postoperative resting echocardiograms performed at our institution with <or=2+ MR preoperatively. This yielded 438 patients. Progression to 3-4+ MR post-CABG was correlated with clinical, electrocardiographic, echocardiographic, and operative variables.
New 3-4+ MR developed in 11 (10%) of the 108 patients with no prior MR, 21 of the 180 (12%) patients with pre-CABG 1+ MR, and 37 of the 150 (25%) patients with pre-CABG 2+ MR. MR progression correlated with female gender (42% vs 27%, p=0.01), history of renal insufficiency (12% vs 5%, p=0.05), prior-CABG (30% vs 17%, p=0.01), lack of beta-blocker use (19% vs 35%, p=0.008), lower incidence of significant PDA stenosis grafted (88% vs 98%, p=0.003), lower preoperative LVEF (42+/-19% vs 50+/-17%, p=0.001), larger LV size (p=0.01), pre-CABG MR grade (p=0.0002), and pre-CABG presence of LBBB block (20% vs 4%, p<0.0001). Independent predictors of MR progression, pre-CABG, were female gender (p=0.002), history of renal insufficiency (p=0.05), lack of beta-blocker use (p=0.006), MR grade (p=0.02), and presence of LBBB (p=0.005).
Development of significant MR following isolated CABG is common and may be related to incomplete myocardium revascularization, especially in the PDA area and LV remodeling. Preoperative, beta-blocker use may be protective against its development.
尽管冠状动脉旁路移植术（CABG）患者中常出现新发二尖瓣反流（MR），但其发生率、预测因素及机制尚不清楚。
在我们的手术登记系统中筛选接受单纯CABG且术前和术后在我院进行静息超声心动图检查、术前MR≤2+的患者。共得到438例患者。CABG术后MR进展至3-4+与临床、心电图、超声心动图及手术变量相关。
108例术前无MR的患者中有11例（10%）出现新发3-4+ MR，180例术前CABG时1+ MR的患者中有21例（12%），150例术前CABG时2+ MR的患者中有37例（25%）。MR进展与女性性别（42%对27%，p=0.01）、肾功能不全病史（12%对5%，p=0.05）、既往CABG史（30%对17%，p=0.01）、未使用β受体阻滞剂（19%对35%，p=0.008）、移植的显著动脉导管未闭狭窄发生率较低（88%对98%，p=0.003）、术前较低的左心室射血分数（42±19%对50±17%，p=0.001）、较大的左心室大小（p=0.01）、术前CABG时的MR分级（p=0.0002）以及术前CABG时存在左束支传导阻滞（20%对4%，p<0.0001）相关。术前CABG时MR进展的独立预测因素为女性性别（p=0.002）、肾功能不全病史（p=0.05）、未使用β受体阻滞剂（p=0.006）、MR分级（p=0.02）及存在左束支传导阻滞（p=0.005）。
单纯CABG后出现显著MR很常见，可能与心肌血运重建不完全有关，尤其是在动脉导管未闭区域和左心室重塑方面。术前使用β受体阻滞剂可能对其发生有保护作用。
