经皮二尖瓣球囊成形术与闭式二尖瓣交界分离术。前瞻性随机研究 15 年随访。

Percutaneous mitral valvotomy versus closed surgical commissurotomy. Up to 15 years of follow-up of a prospective randomized study.

机构信息

Cardiology Department, Faculty of Medicine, Ain Shams University, Cairo, Egypt.

出版信息

J Cardiol. 2009 Feb;53(1):28-34. doi: 10.1016/j.jjcc.2008.08.003. Epub 2008 Sep 27.

DOI:10.1016/j.jjcc.2008.08.003

PMID:19167635

Abstract

BACKGROUND

Immediate and intermediate term results of percutaneous mitral valvotomy (PMV) are comparable to closed surgical commissurotomy (CSC). We aimed at exploring this relation in the long term.

METHODS

Previously, we randomized 40 consecutive patients with moderate to severe mitral stenosis [defined as mitral valve area (MVA) less than 1.5 cm²] to undergo either PMV (PMV group = 20 patients) or CSC (CSC group = 20 patients). For all patients, full echocardiographic assessment was performed before the procedure/operation. Patients assigned to PMV underwent the double balloon technique. Echocardiographic assessment was done following both procedures before discharge and repeated 1 and 6 months later. Echocardiographic follow-up was performed, thereafter, on a yearly basis for up to 15 years, with a mean follow-up period of 99 ± 12 months.

RESULTS

Immediate echocardiographic results showed no statistically significant difference between the 2 groups regarding the final MVA or mean diastolic gradient across the mitral valve. Two patients dropped out from the CSC group and one from the PMV group. MVA was 1.8 ± 0.3 cm² versus 1.8 ± 0.4 cm² (p > 0.05) and mean diastolic pressure gradient across the mitral valve was 7 ± 4 mmHg versus 6.6 ± 4 mmHg (p > 0.05) in the PMV and CSC groups, respectively. Mitral restenosis occurred in 5 (26.3%) patients in the PMV group versus 5 (27.8%) patients in the CSC group (p > 0.05). Kaplan-Meier curves for restenosis-free survival showed no difference between the 2 groups.

CONCLUSION

PMV achieves comparable results to CSC both in the short and long term.

摘要

背景

经皮二尖瓣切开术（PMV）的即刻和中期结果与闭式二尖瓣交界分离术（CSC）相当。我们旨在探索长期的相关结果。

方法

此前，我们随机选择了 40 例中重度二尖瓣狭窄患者（定义为二尖瓣瓣口面积（MVA）<1.5cm²），分别接受 PMV（PMV 组=20 例）或 CSC（CSC 组=20 例）治疗。所有患者在手术前均进行了全面的超声心动图评估。接受 PMV 治疗的患者采用双球囊技术。在出院前和 1 个月及 6 个月后进行了两次术后超声心动图评估。此后，每年进行超声心动图随访，随访时间长达 15 年，平均随访时间为 99±12 个月。

结果

即刻超声心动图结果显示，两组在最终 MVA 或二尖瓣瓣口舒张期平均压差方面无统计学差异。CSC 组有 2 例患者和 PMV 组有 1 例患者脱落。PMV 组和 CSC 组的 MVA 分别为 1.8±0.3cm²和 1.8±0.4cm²（p>0.05），二尖瓣瓣口舒张期平均压差分别为 7±4mmHg 和 6.6±4mmHg（p>0.05）。PMV 组有 5 例（26.3%）患者发生二尖瓣再狭窄，CSC 组有 5 例（27.8%）患者发生二尖瓣再狭窄（p>0.05）。再狭窄无事件生存的 Kaplan-Meier 曲线显示两组之间无差异。