Kasegawa Hitoshi, Shimokawa Tomoki, Shibazaki Ikuko, Hayashi Hiroki, Koyanagi Toshiya, Ida Takao
Department of Cardiovascular Surgery, Sakakibara Heart Institute, Tokyo, Japan.
Ann Thorac Surg. 2006 May;81(5):1625-31. doi: 10.1016/j.athoracsur.2005.11.032.
This study was a long-term Doppler echocardiographic assessment of mitral valve repair for anterior mitral leaflet prolapse using expanded polytetrafluoroethylene sutures.
Between April 1992 and December 2003, we performed mitral valve repair using expanded polytetrafluoroethylene sutures in 204 patients (mean age, 54.6 years) with severe mitral regurgitation (MR) having anterior mitral leaflet prolapse. The cause of valve disease was degenerative in 181 patients (88.7%). Postoperative serial transthoracic echocardiographic studies were performed in all hospital survivors. Residual MR flow detected by color Doppler echocardiography was classified according to the maximum regurgitant jet area.
The 30-day mortality of 204 patients was 1.4% (3 deaths). There were 12 late deaths and 14 reoperations in this series. Kaplan-Meier survival and freedom from reoperation at 12 years were 84.6% +/- 4.0% and 89.9% +/- 2.9%, respectively. Postoperative transthoracic echocardiographic assessment after discharge (mean follow-up, 4.2 +/- 3.0 years) showed less than mild regurgitation (maximum regurgitant jet area < 4.0 cm2) in 80.9% of the patients. Overall, freedom from severe MR (maximum regurgitant jet area > or = 7.0 cm2) estimates at 12 years were 88.1% +/- 3.1%. Freedom from severe MR at 12 years for 114 patients with no MR (maximum regurgitant jet area = 0 cm2) on intraoperative transesophageal echocardiography and 77 patients with MR was 95.3% +/- 2.1% and 82.9% +/- 5.1%, respectively (p = 0.033).
Twelve-year echocardiographic follow-up demonstrates good long-term results of chordal replacement with expanded polytetrafluoroethylene sutures for anterior mitral leaflet prolapse. To avoid recurrence of regurgitation, a significantly high level of competence of the valve is essential in the repair of anterior mitral leaflet prolapse.
本研究是一项使用膨体聚四氟乙烯缝线对二尖瓣前叶脱垂进行二尖瓣修复的长期多普勒超声心动图评估。
1992年4月至2003年12月期间，我们对204例（平均年龄54.6岁）患有严重二尖瓣反流（MR）且二尖瓣前叶脱垂的患者使用膨体聚四氟乙烯缝线进行二尖瓣修复。181例（88.7%）患者的瓣膜病病因是退行性变。对所有出院存活患者进行术后系列经胸超声心动图检查。通过彩色多普勒超声心动图检测到的残余MR血流根据最大反流束面积进行分类。
204例患者的30天死亡率为1.4%（3例死亡）。本系列中有12例晚期死亡和14例再次手术。12年时的Kaplan-Meier生存率和免于再次手术率分别为84.6%±4.0%和89.9%±2.9%。出院后经胸超声心动图评估（平均随访4.2±3.0年）显示，80.9%的患者反流程度小于轻度（最大反流束面积<4.0 cm²）。总体而言，12年时免于严重MR（最大反流束面积≥7.0 cm²）的估计值为88.1%±3.1%。术中经食管超声心动图检查无MR（最大反流束面积=0 cm²）的114例患者和有MR的77例患者在12年时免于严重MR的比例分别为95.3%±2.1%和82.9%±5.1%（p = 0.033）。
12年的超声心动图随访显示，使用膨体聚四氟乙烯缝线进行腱索置换治疗二尖瓣前叶脱垂具有良好的长期效果。为避免反流复发，在二尖瓣前叶脱垂修复中，瓣膜具有显著高水平的功能至关重要。
