Kasegawa Hitoshi, Shimokawa Tomoki, Horai Tetsuya, Takeuchi Susumu, Nishimura Kenji, Ozawa Naomi, Takanashi Shuichiro
Division of Cardiovascular Surgery, The Sakakibara Heart Institute, Tokyo, Japan.
J Heart Valve Dis. 2008 Mar;17(2):162-7.
The study aim was to assess the long-term durability of mitral valve (MV) repair for MV prolapse using echo-Doppler evaluation.
Between July 1991 and December 2006, MV repair was performed in 603 patients with nonischemic, severe mitral regurgitation (MR). A subset of 517 patients (mean age 56.3 +/- 12.0 years) with MR caused by leaflet prolapse resulting from degeneration of the MV was subsequently investigated. The main techniques used for MV repair included chordal replacement with ePTFE sutures for 274 of 278 patients with anterior leaflet (AL) prolapse, and leaflet resection for 239 patients with posterior leaflet (PL) prolapse. A prosthetic ring or band was used for annuloplasty in 340 patients, and a band of autologous pericardium in 161; no ring or band was used in the remaining 16 cases. Postoperative serial transthoracic echocardiography was performed for all hospital survivors before discharge, and on at least one occasion after discharge in 507 patients. Echocardiographic follow up was available for up to 15 years (mean 4.4 +/- 3.6 years). Residual MR flow detected by color Doppler echocardiography was classified according to the maximum regurgitant jet area (MRA).
The 30-day mortality was 0.57% (three deaths). There were 21 late deaths and 22 reoperations (five of which were re-repair for hemolysis). Kaplan-Meier survival and freedom from reoperation at 14 years were 79.0 +/- 6.0% and 74.5 +/- 9.6%, respectively. Estimates of freedom from severe MR (MRA > or = 7.0 cm2) at five, 10 and 14 years were 94.2 +/- 1.5%, 82.8 +/- 3.6% and 77.5 +/- 5.5%, respectively. Freedom from severe MR at 14 years for 239 patients with isolated PL prolapse was 98.4 +/- 1.6%.
Echocardiographic follow up of MV repair for MV prolapse demonstrates good long-term results. In particular, the results of MV repair for isolated PL prolapse were excellent.
本研究旨在通过超声多普勒评估，评估二尖瓣脱垂二尖瓣修复术的长期耐久性。
1991年7月至2006年12月期间，对603例非缺血性重度二尖瓣反流（MR）患者进行了二尖瓣修复术。随后对其中517例因二尖瓣退变导致瓣叶脱垂引起MR的患者（平均年龄56.3±12.0岁）进行了研究。二尖瓣修复的主要技术包括：278例前叶（AL）脱垂患者中的274例采用ePTFE缝线进行腱索置换，239例后叶（PL）脱垂患者进行瓣叶切除。340例患者采用人工瓣环或带进行瓣环成形术，161例采用自体心包带；其余16例未使用瓣环或带。所有出院存活患者在出院前均进行了系列经胸超声心动图检查，507例患者出院后至少进行了一次检查。超声心动图随访时间长达15年（平均4.4±3.6年）。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（MRA）进行分类。
30天死亡率为0.57%（3例死亡）。有21例晚期死亡和22例再次手术（其中5例因溶血进行再次修复）。14年时的Kaplan-Meier生存率和免于再次手术率分别为79.0±6.0%和74.5±9.6%。5年、10年和14年时免于严重MR（MRA≥7.0 cm²）的估计值分别为94.2±1.5%、82.8±3.6%和77.5±5.5%。239例孤立性PL脱垂患者14年时免于严重MR的比例为98.4±1.6%。
二尖瓣脱垂二尖瓣修复术的超声心动图随访显示出良好的长期效果。特别是，孤立性PL脱垂的二尖瓣修复结果非常好。
