Fucci Carlo, Cicco Giuseppe De, Chiari Ermanna, Nardi Matilde, Faggiano Pompilio, Procopio Roberto, Coletti Giuseppe, Rambaldini Manfredo, Lorusso Roberto
Operative Unit of Cardiac Surgery, Brescia, Italy.
J Cardiovasc Med (Hagerstown). 2007 May;8(5):354-8. doi: 10.2459/01.JCM.0000268120.45303.cf.
The use of new techniques to correct mitral regurgitation due to prolapse of the anterior leaflet has been shown to expand the original surgical armamentarium and to improve postoperative outcome. We retrospectively analysed our experience with isolated prolapse of the anterior mitral leaflet repaired using the edge-to-edge technique.
From October 1986 to June 2004, 790 patients underwent mitral valve repair for mitral regurgitation at our institution. Isolated pathology of the anterior mitral leaflet, due to degenerative disease, was the cause of mitral regurgitation in 84 patients and, from 1991, 68 underwent edge-to-edge repair.
There was no intraoperative death and one in-hospital death. Three patients died in the late follow-up period for a cumulative 13-year survival rate of 90 +/- 1.4%. No patient underwent early reoperation. Four patients underwent reoperation during the follow-up for a cumulative 13-year freedom from reoperation of 92.3 +/- 3.2%. At echocardiographic evaluation, mitral valve repair failure was associated with severe mitral regurgitation in four patients. Of the remaining 60 patients, 40 had no residual regurgitation, 18 had trivial residual regurgitation, and two had mild regurgitation. At follow-up, 49 patients are still in New York Heart Association (NYHA) class I, 14 in NYHA class II and only one in NYHA class III.
Our study demonstrates that the 'edge-to-edge' technique is a reliable procedure to correct prolapsing leaflets. The addition of this technique to the surgical armamentarium has neutralized prolapse of the anterior leaflet as an incremental risk factor for reoperation.
已证实采用新技术纠正因前叶脱垂所致二尖瓣反流可扩充原有的手术手段并改善术后结果。我们回顾性分析了采用缘对缘技术修复单纯前叶二尖瓣脱垂的经验。
1986年10月至2004年6月，我院790例患者因二尖瓣反流接受二尖瓣修复术。84例患者因退行性疾病导致单纯前叶病变，为二尖瓣反流的病因，自1991年起，68例接受了缘对缘修复术。
无术中死亡，1例院内死亡。3例患者在晚期随访期死亡，累积13年生存率为90±1.4%。无患者接受早期再次手术。4例患者在随访期间接受再次手术，累积13年免于再次手术率为92.3±3.2%。经超声心动图评估，4例患者二尖瓣修复失败与严重二尖瓣反流相关。其余60例患者中，40例无残余反流，18例有微量残余反流，2例有轻度反流。随访时，49例患者仍处于纽约心脏协会（NYHA）I级，14例处于NYHA II级，仅1例处于NYHA III级。
我们的研究表明，“缘对缘”技术是纠正脱垂瓣叶的可靠方法。将该技术添加到手术手段中已消除前叶脱垂作为再次手术的增量危险因素。
