Calafiore Antonio M, Di Mauro Michele, Iacò Angela L, Mazzei Valerio, Teodori Giovanni, Gallina Sabina, Weltert Luca, Samoun Mauricette, Di Giammarco Gabriele
Division of Cardiac Surgery, University Hospital, Turin, Italy.
Ann Thorac Surg. 2006 Apr;81(4):1310-6. doi: 10.1016/j.athoracsur.2005.08.031.
The concept of overreduction of the posterior annulus was applied in surgical treatment of degenerative mitral valve disease.
From April 1993 to November 2004, 141 patients underwent overreduction of the posterior annulus of the mitral valve in mitral valve repair for degenerative disease. Mean scallop involvement per patient was 2.3 and increased to 3.0 in the last period. Correction of the prolapse of the posterior leaflet included resection with focal sliding (n = 100), or application of artificial chordae (n = 28), with (n = 11) or without (n = 17) plication of one or more scallops. The anterior leaflet prolapse was corrected with edge-to-edge technique (n = 20) or chordal replacement (n = 28). An overreducting ring, 40 (n = 81) or 50 (n = 60) mm long (autologous pericardium in 64 cases and Sovering Miniband [Sorin, Saluggia, Italy] in 77) was used in all the patients.
Three patients died in the early period (2.1%) and 3 (2.1%) were reoperated on from 3 to 24 months due to endocarditis (2 cases) and failure of repair (1 case). Ten-year freedom from death any cause was 91.6%, from reoperation 96.4%, from death any cause and reoperation 87.7%, from death any cause, reoperation, and New York Heart Association class III-IV 79.8%. Sixty-four patients out of 68 who survived more than 2 years (94.1%) at a mean follow up of 4.2 +/- 2.5 years had no or 1+ residual mitral regurgitation.
Although the complexity of mitral valve repair for degenerative disease increased, results of surgery remained stable. Apposition of a posterior overreductive ring was useful to cover any mistake performed during the correction.
二尖瓣后瓣环过度缩小的概念应用于退行性二尖瓣疾病的外科治疗。
1993年4月至2004年11月，141例患者因退行性疾病在二尖瓣修复术中接受了二尖瓣后瓣环过度缩小术。每位患者平均累及2.3个扇区，最后阶段增加至3.0个扇区。纠正后叶脱垂包括局部滑动切除（n = 100）或应用人工腱索（n = 28），其中1个或多个扇区有（n = 11）或无（n = 17）折叠。前叶脱垂采用缘对缘技术（n = 20）或腱索置换（n = 28）进行纠正。所有患者均使用了长度为40（n = 81）或50（n = 60）mm的过度缩小环（64例为自体心包，77例为Sovering Miniband [索林，意大利萨卢贾]）。
3例患者在早期死亡（2.1%），3例（2.1%）在3至24个月内因心内膜炎（2例）和修复失败（1例）接受再次手术。任何原因导致的10年无死亡生存率为91.6%，再次手术率为96.4%，任何原因导致的死亡和再次手术率为87.7%，任何原因导致的死亡、再次手术以及纽约心脏协会III-IV级的发生率为79.8%。在平均随访4.2±2.5年的68例存活超过2年的患者中，64例（94.1%）无或仅有1+级残余二尖瓣反流。
尽管退行性疾病二尖瓣修复的复杂性增加，但手术结果保持稳定。后置过度缩小环有助于弥补纠正过程中出现的任何失误。
