Serri K, Bouchard D, Demers P, Coutu M, Pellerin M, Carrier M, Perrault L P, Cartier R, Pagé P, Cossette M, Basmadjian A J
Montreal Heart Institute, University of Montreal, Montreal, Quebec, Canada.
J Thorac Cardiovasc Surg. 2006 Mar;131(3):565-573.e2. doi: 10.1016/j.jtcvs.2005.09.037. Epub 2006 Jan 31.
Chronic ischemic mitral regurgitation is associated with poor long-term survival. Despite the increasing popularity of valve repair, its durability and long-term outcome for ischemic mitral regurgitation have recently been questioned.
Seventy-eight patients underwent repair for ischemic mitral regurgitation between 1996 and 2002 at our institution. Of these patients, 73 had complete clinical and echocardiographic follow-up. Preoperative, intraoperative, and postoperative clinical data were obtained, and the results of echocardiograms were reviewed to assess the rate of recurrence of regurgitation after repair and to identify predictive factors.
The mean preoperative mitral regurgitation grade, New York Heart Association class, and left ventricular ejection fraction were 2.72, 2.65, and 39.4%, respectively. Mortality was 12.3% at 30 days and 30.1% at a mean follow-up of 39 +/- 25 months. Immediate postoperative echocardiography showed absent or mild mitral regurgitation in 89.4% of patients and showed moderate mitral regurgitation in 10.6%. Freedom from reoperation was 93.2%. Recurrent moderate mitral regurgitation (2+) was present in 36.7% of patients, and severe mitral regurgitation (3+ to 4+) was present in 20.0% at mean follow-up of 28.1 +/- 22.5 months. Only age (P = .0130) and less marked preoperative posterior tethering (P = .0362) were predictive of recurrent mitral regurgitation. Patients with a preoperative New York Heart Association class greater than II and recurrent mitral regurgitation greater than 2+ had decreased survival (P = .0152 and P = .0450, respectively).
Significant recurrent mitral regurgitation occurs following repair for ischemic mitral regurgitation, despite good early results. This finding raises questions about the need for improved repair techniques, better patient selection, or eventual mitral valve replacement in selected patients.
慢性缺血性二尖瓣反流与长期生存率低相关。尽管瓣膜修复越来越受欢迎，但其对缺血性二尖瓣反流的耐久性和长期结果最近受到质疑。
1996年至2002年期间，我们机构有78例患者接受了缺血性二尖瓣反流修复术。其中，73例患者有完整的临床和超声心动图随访。获取术前、术中和术后的临床数据，并回顾超声心动图结果，以评估修复术后反流复发率并确定预测因素。
术前二尖瓣反流平均分级、纽约心脏协会分级和左心室射血分数分别为2.72、2.65和39.4%。30天死亡率为12.3%，平均随访39±25个月时死亡率为30.1%。术后即刻超声心动图显示89.4%的患者无或轻度二尖瓣反流，10.6%的患者显示中度二尖瓣反流。再次手术的自由度为93.2%。平均随访28.1±22.5个月时，36.7%的患者出现中度二尖瓣反流复发（2+），20.0%的患者出现重度二尖瓣反流（3+至4+）。只有年龄（P = 0.0130）和术前较少明显的后叶瓣下结构受限（P = 0.0362）可预测二尖瓣反流复发。术前纽约心脏协会分级大于II级且二尖瓣反流复发大于2+的患者生存率降低（分别为P = 0.0152和P = 0.0450）。
尽管早期结果良好，但缺血性二尖瓣反流修复术后仍会出现明显的二尖瓣反流复发。这一发现引发了关于是否需要改进修复技术、更好地选择患者或最终对部分患者进行二尖瓣置换的问题。
