Kuwaki Kenji, Kawaharada Nobuyoshi, Morishita Kiyofumi, Koyanagi Tetsuya, Osawa Hisayoshi, Maeda Toshiyuki, Higami Tetsuya
Department of Thoracic and Cardiovascular Surgery, Sapporo Medical University School of Medicine, Sapporo, Japan.
Ann Thorac Surg. 2007 Feb;83(2):558-63. doi: 10.1016/j.athoracsur.2006.08.015.
The purpose of this study was to compare the late results of combined mitral valve repair and aortic valve replacement with double valve replacement for patients with rheumatic heart disease.
From 1981 to 2003, 128 patients underwent aortic valve replacement with either mitral valve repair (n = 47) or mitral valve replacement (n = 81) for rheumatic disease. Mean follow-up was 9.1 +/- 4.5 years.
Rates of actuarial freedom from cardiac-related death (81.4% versus 75.9% at 12 years; p = 0.60), thromboembolism (79.8% versus 85.1% at 12 years; p = 0.78), and bleeding (97.3% versus 95.7% at 12 years; p = 0.77) were similar in both combined mitral valve repair and aortic valve replacement and double valve replacement. However, freedom from mitral valve reoperation was significantly lower in combined mitral valve repair and aortic valve replacement compared with double valve replacement (52.6% versus 76.8% at 12 years; p = 0.002). Mitral valve repair (p = 0.002) and mitral bioprosthesis (p = 0.0001) were independent risk factors for mitral valve reoperation.
Potential advantages of preserving, rather than replacing, the native mitral valve, such as better cardiac survival or fewer thromboembolic complications, were not identified in combined mitral valve repair and aortic valve replacement compared with double valve replacement for patients with rheumatic disease. Indeed, combined mitral valve repair and aortic valve replacement was associated with a significantly higher incidence of mitral valve reoperation. Therefore, in double valve surgery for rheumatic disease, mitral valve repair should be limited to the correction of mitral valve lesions only when excellent durability can be expected.
本研究的目的是比较风湿性心脏病患者二尖瓣修复联合主动脉瓣置换与双瓣置换的远期结果。
1981年至2003年，128例患者因风湿性疾病接受了主动脉瓣置换，其中二尖瓣修复（n = 47）或二尖瓣置换（n = 81）。平均随访时间为9.1±4.5年。
二尖瓣修复联合主动脉瓣置换和双瓣置换在心脏相关死亡（12年时分别为81.4%和75.9%；p = 0.60）、血栓栓塞（12年时分别为79.8%和85.1%；p = 0.78）以及出血（12年时分别为97.3%和95.7%；p = 0.77）方面的无事件生存率相似。然而，与双瓣置换相比，二尖瓣修复联合主动脉瓣置换后二尖瓣再次手术的无事件生存率显著降低（12年时分别为52.6%和76.8%；p = 0.002）。二尖瓣修复（p = 0.002）和二尖瓣生物瓣（p = 0.0001）是二尖瓣再次手术的独立危险因素。
对于风湿性疾病患者，与双瓣置换相比，二尖瓣修复联合主动脉瓣置换未发现保留而非置换天然二尖瓣的潜在优势，如更好的心脏生存率或更少的血栓栓塞并发症。事实上，二尖瓣修复联合主动脉瓣置换与二尖瓣再次手术的发生率显著升高相关。因此，在风湿性疾病的双瓣手术中，二尖瓣修复应仅限于预期耐久性良好时对二尖瓣病变的纠正。
