[二尖瓣前叶脱垂修复术：腱索置换与腱索缩短的比较]

Gan Hui-li, Zhang Jian-qun, Wang Sheng-xun, Zhou Qi-wen, Kong Qing-yu, Zheng Si-hong, Bo Ping, Huang Guo-hui, Chen Wei

Department of Cardiac Surgery, Beijing Anzhen Hospital, Capital Medical University (BAZH-CMU), Beijing Institute of Heart, Lung and Vessel Disease, Beijing 100029, China.

Zhonghua Wai Ke Za Zhi. 2008 Nov 15;46(22):1727-9.

OBJECTIVE

To compare the relative merits between chordal shortening and artificial chordae to repair the anterior leaflet prolapses (ALP).

METHODS

The clinic data of 50 cases underwent repair of ALP from March 1990 to March 2008 were analyzed retrospectively. There were 29 male and 21 female patients with a mean age of (42.6 +/- 11.3) years old. There were 23 patients in chordal shortening group and 27 patients in artificial chordae group.

RESULTS

There were 3 operative deaths in chordal shortening group (13.0%), and 1 death in artificial chordae group (3.7%, P = 0.199). With a mean follow-up of (5.8 +/- 4.8) years and a total follow-up of 278 patient-years, there were 3 late deaths respectively in each group. According the Kaplan-Meier survival curve, the actuarial survival rate at 5-8 years was 70.0% +/- 18.2% for chordal shortening group and 86.8% +/- 9.2% for artificial chordae group (chi(2) = 8.17, P = 0.046). There were 5 reoperations, of which 4 in chordal shortening group and 1 in artificial chordae group. According to the Kaplan-Meier freedom from reoperation curve, the freedom from reoperation at 5 years was 83.3% +/- 15.2% for chordal shortening group and 100% for artificial chordae group (chi(2) = 12.06, P = 0.007). The COX proportional hazard regressions revealed that chordal-shortening technique was the independent risk predictor for the late cardiac event after ALP surgical repair.

CONCLUSION

Artificial chordae techniques has a relative superiority to chordal shortening for repair of mitral valve ALP.

目的

比较腱索缩短术与人工腱索修复二尖瓣前叶脱垂（ALP）的相对优缺点。

方法

回顾性分析1990年3月至2008年3月期间50例行ALP修复术患者的临床资料。其中男性29例，女性21例，平均年龄（42.6±11.3）岁。腱索缩短组23例，人工腱索组27例。

结果

腱索缩短组有3例手术死亡（13.0%），人工腱索组有1例死亡（3.7%，P = 0.199）。平均随访（5.8±4.8）年，总随访278患者年，每组各有3例晚期死亡。根据Kaplan-Meier生存曲线，腱索缩短组5至8年的精算生存率为70.0%±18.2%，人工腱索组为86.8%±9.2%（χ² = 8.17，P = 0.046）。有5例再次手术，其中腱索缩短组4例，人工腱索组1例。根据Kaplan-Meier无再次手术曲线，腱索缩短组5年无再次手术率为83.3%±15.2%，人工腱索组为100%（χ² = 12.06，P = 0.007）。COX比例风险回归显示，腱索缩短技术是ALP手术修复后晚期心脏事件的独立风险预测因素。