Sirivella Srikrishna, Gielchinsky Isaac
Newark Beth Israel Medical Center, Department of Cardiovascular and Thoracic Surgery, Newark University of Medicine & Dentistry of New Jersey, Newark, NJ 07112, USA.
Interact Cardiovasc Thorac Surg. 2006 Aug;5(4):392-7. doi: 10.1510/icvts.2006.128785. Epub 2006 May 3.
The impact of etiology of associated mitral valve regurgitation and a valve procedure on operative and long-term outcomes after coronary bypass grafting surgery is yet to be clearly defined. Results of combined coronary artery bypass grafting and valve procedures for mitral valve regurgitation were retrospectively analyzed in 468 patients. The regurgitation was of ischemic in 45%, degenerative in 55% and 78% valve repairs, 22% valve replacements were performed. Severe coronary artery disease, acute myocardial infarction, low ejection fraction, ischemic mitral regurgitation, advanced heart failure symptoms, failure to use internal mammary artery, valve replacement surgery, and emergency operations are predictors of operative mortality. The 5-year survivals for propensity-matched patients of ischemic and degenerative disease were similar (66%), but 67% vs. 83%, respectively, for unmatched patients. Low ejection fraction (<35%), advanced age (>67 years), valve replacement surgery, residual mitral regurgitation, and severe coronary artery disease were predictors of poor long-term survival. Left ventricular remodeling processes, optimal valve procedure without residual mitral regurgitation and left ventricular function are important determinants of long-term outcome than the etiology of valve regurgitation.
相关二尖瓣反流的病因及瓣膜手术对冠状动脉旁路移植术后手术及长期预后的影响尚未明确界定。对468例接受冠状动脉旁路移植术联合二尖瓣反流瓣膜手术的患者结果进行回顾性分析。反流病因中45%为缺血性，55%为退行性，78%进行瓣膜修复，22%进行瓣膜置换。严重冠状动脉疾病、急性心肌梗死、低射血分数、缺血性二尖瓣反流、晚期心力衰竭症状、未使用乳内动脉、瓣膜置换手术及急诊手术是手术死亡率的预测因素。缺血性和退行性疾病倾向匹配患者的5年生存率相似（66%），但未匹配患者分别为67%和83%。低射血分数（<35%）、高龄（>67岁）、瓣膜置换手术、二尖瓣反流残留及严重冠状动脉疾病是长期生存不良的预测因素。左心室重构过程、无二尖瓣反流残留的最佳瓣膜手术及左心室功能比瓣膜反流病因更重要，是长期预后的决定因素。
