Talwar Sachin, Mathur Ankit, Choudhary Shiv Kumar, Singh Rajvir, Kumar Arkalgud Sampath
Cardiothoracic Centre, All India Institute of Medical Sciences, New Delhi, India.
Ann Thorac Surg. 2007 Oct;84(4):1219-25. doi: 10.1016/j.athoracsur.2007.04.115.
Double valve replacement is associated with reduced long-term survival. This study investigates aortic valve replacement with mitral valve repair as an alternative to double valve replacement in patients with rheumatic heart disease (RHD).
Between January 1995 and December 2005, 369 patients with RHD underwent combined aortic and mitral valve procedures. In 76 patients (20.6%), mitral valve repair with aortic valve replacement (group 1) was done. The remaining 293 patients (79.4%) underwent double valve replacement (group 2). A total of 351 patients (95%)--73 (96%) in group 1 and 278 (94.8%) in group 2--were 50 years of age or younger.
There was no difference in early mortality in the groups (4 in group 1 versus 25 in group 2, p = 0.35). The median follow-up was 60 months (range, 6 to 132 months) and 96% complete in group 1 and 92% in group 2. Actuarial survival was 90.5% +/- 3.4% in group 1 and 81.60% +/- 2.4% in group 2 at 60 months (p = 0.07). Event-free survival at 60 months was 78.3% +/- 5.1% in group 1 and 48.4 % +/- 3.2% in group 2 (p < 0.001). Reoperation-free survival was 92.5% +/- 0.4% in group 1 and 99.5% +/- 0.05% in group 2 (p = 0.014).
Mitral valve repair with aortic valve replacement provides significantly better event-free survival than double valve replacement without a better actuarial survival. Reoperation rates are higher in the mitral valve repair and aortic valve replacement group, whereas thromboembolic complications were more in the double valve replacement group. Better event-free survival in patients undergoing mitral valve repair and aortic valve replacement still argues in favor of repair of the mitral valve whenever possible.
双瓣膜置换术与长期生存率降低相关。本研究探讨在风湿性心脏病（RHD）患者中，主动脉瓣置换联合二尖瓣修复作为双瓣膜置换术替代方案的效果。
1995年1月至2005年12月期间，369例RHD患者接受了主动脉瓣和二尖瓣联合手术。其中76例患者（20.6%）进行了二尖瓣修复联合主动脉瓣置换术（第1组）。其余293例患者（79.4%）接受了双瓣膜置换术（第2组）。共有351例患者（95%）——第1组73例（96%），第2组278例（94.8%）——年龄在50岁及以下。
两组患者的早期死亡率无差异（第1组4例，第2组25例，p = 0.35）。中位随访时间为60个月（范围6至132个月），第1组随访完整率为96%，第2组为92%。60个月时，第1组的精算生存率为90.5%±3.4%，第2组为81.60%±2.4%（p = 0.07）。60个月时，第1组的无事件生存率为78.3%±5.1%，第2组为48.4%±3.2%（p < 0.001）。第1组的无再次手术生存率为92.5%±0.4%，第2组为99.5%±0.05%（p = 0.014）。
二尖瓣修复联合主动脉瓣置换术的无事件生存率明显优于双瓣膜置换术，但精算生存率无显著差异。二尖瓣修复联合主动脉瓣置换术组的再次手术率较高，而双瓣膜置换术组的血栓栓塞并发症较多。二尖瓣修复联合主动脉瓣置换术患者具有更好的无事件生存率，这仍然支持尽可能对二尖瓣进行修复。
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