Lawrie Gerald M, Earle Elizabeth A, Earle Nan R
The Methodist DeBakey Heart Center, Houston, Texas, USA.
Ann Thorac Surg. 2006 Mar;81(3):849-56; discussion 856. doi: 10.1016/j.athoracsur.2005.08.077.
Mitral valve repair of the anterior leaflet has been more difficult than at other sites.
Between February 1983 and June 2004, 607 mitral valve repairs were performed on one service. Of these, 410 patients had leaflet repair procedures: 152 were anterior leaflet repairs; isolated in 94, and combined with posterior repair in 58 patients. The results in these patients were compared with the results of posterior leaflet repair in 258 patients. All patients received flexible ring annuloplasty.
Age and sex of the anterior leaflet and posterior leaflet patients were similar: mean age 62.5 +/- 14.3, 62.9 +/- 14.9 years; males, 50.6%, p = not significant (NS). Preoperative ejection fraction was for anterior repairs 52.6 +/- 12.8%; posterior repair, 58.2 +/- 11.8%, p = NS. Coronary artery bypass was more frequently performed with anterior leaflet repair in 18 patients (19.1%) versus 45 (6.6%) for posterior leaflet repair (p = NS). The median number of chordae was similar in the anterior leaflet and posterior leaflet patients 4 (2-8), 4 (2-6), p = NS. Perioperative mortality was similar: anterior leaflet patients, 3.3% (2/94); posterior leaflet patients, 1.1% (2/258), p = NS. Hospital stay was for anterior leaflet patients and posterior leaflet patients: 12.86 +/- 13.3 vs 11.0 +/- 12.3, p = NS. Kaplan-Meier estimates of freedom from reoperation at 3 years were: for anterior leaflet patients, 91.9%: for posterior leaflet patients, 90.7%, p = 0.77. No structural polytetrafluoroethylene (PTFE) chordal failures were observed. Late echocardiographic data were obtained in 136 patients on 222 occasions at a mean of 3.2 +/- 3.34 years. Severe mitral regurgitation was present in 10 patients (7.3%).
Repair of the anterior leaflet is facilitated by the use of PTFE replacement. Anterior leaflet repair can be performed reproducibly with the same results as posterior leaflet repair.
二尖瓣前叶修复比其他部位更困难。
1983年2月至2004年6月，同一科室共进行了607例二尖瓣修复手术。其中，410例患者接受了瓣叶修复手术：152例为前叶修复；单纯前叶修复94例，前叶修复联合后叶修复58例。将这些患者的结果与258例后叶修复患者的结果进行比较。所有患者均接受了弹性环成形术。
前叶和后叶修复患者的年龄和性别相似：平均年龄分别为62.5±14.3岁、62.9±14.9岁；男性比例分别为50.6%，p = 无显著差异（NS）。前叶修复患者术前射血分数为52.6±12.8%；后叶修复患者为58.2±11.8%，p = NS。18例（19.1%）前叶修复患者较45例（6.6%）后叶修复患者更常进行冠状动脉旁路移植术（p = NS）。前叶和后叶修复患者的腱索中位数相似，分别为4（2 - 8）、4（2 - 6），p = NS。围手术期死亡率相似：前叶修复患者为3.3%（2/94）；后叶修复患者为1.1%（2/258），p = NS。前叶和后叶修复患者的住院时间分别为：12.86±13.3天和11.0±12.3天，p = NS。3年时Kaplan - Meier法估计的再次手术自由度为：前叶修复患者为91.9%；后叶修复患者为90.7%，p = 0.77。未观察到结构性聚四氟乙烯（PTFE）腱索失效。136例患者在平均3.2±3.34年的时间里接受了222次晚期超声心动图检查。10例患者（7.3%）存在严重二尖瓣反流。
使用PTFE替代有助于前叶修复。前叶修复可以重复进行，结果与后叶修复相同。
