El Oumeiri Bachar, Boodhwani Munir, Glineur David, De Kerchove Laurent, Poncelet Alain, Astarci Parla, Pasquet Agnes, Vanoverschelde Jean-Louis, Verhelst Robert, Rubay Jean, Noirhomme Philipe, El Khoury Gébrine
Department of Cardiovascular and Thoracic Surgery, Cliniques Universitaires Saint-Luc, Brussels, Belgium.
Ann Thorac Surg. 2009 Jun;87(6):1735-40. doi: 10.1016/j.athoracsur.2009.03.009.
Repair of rheumatic mitral valves has met with limited success because hemodynamic obstruction may persist after repair because of residual diseased leaflet tissue and lack of suppleness. Over the past decade, we have developed and implemented an aggressive approach to rheumatic mitral valve repair with radical excision of the diseased leaflets area, and subvalvular apparatus and subsequent reconstruction, with the objective of removing all diseased valvular tissue.
From July 1996 to June 2007, 78 patients underwent mitral valve repair for rheumatic valve disease. Over the same time interval, 54 patients underwent mitral valve replacement. Mean age was 56.4 +/- 16 years. Clinical follow-up (mean 60 +/- 36 months) was complete in 100% of patients, and echocardiographic follow-up (mean 52 +/- 37 months) was 96% complete.
There was no hospital mortality or early reoperations. Overall survival was 94% +/- 6% at 8 years, and 95% of patients were in New York Heart Association functional class II or less. Three patients (4%) required reoperation for mitral restenosis and 2 underwent re-repair. At 8 years of follow-up, freedom from cardiac death and mitral valve reoperation were 98% +/- 2% and 94% +/- 5%, respectively. Freedom from valve-related events at 5 and 10 years was 90% +/- 8% and 86% +/- 11%, and freedom from significant mitral regurgitation was 98% +/- 2% at 5 years and 83% +/- 9% at 8 years.
A more aggressive approach to resection of diseased valvular tissue with subsequent reconstruction is feasible, with good midterm results, and may extend the scope of valve repair in rheumatic disease patients.
风湿性二尖瓣修复术的成功率有限，因为修复后由于残留病变瓣叶组织和缺乏柔顺性，血流动力学梗阻可能持续存在。在过去十年中，我们开发并实施了一种积极的风湿性二尖瓣修复方法，即彻底切除病变瓣叶区域和瓣下结构，随后进行重建，目的是清除所有病变瓣膜组织。
1996年7月至2007年6月，78例患者因风湿性瓣膜病接受二尖瓣修复术。在同一时间段内，54例患者接受二尖瓣置换术。平均年龄为56.4±16岁。100%的患者完成了临床随访（平均60±36个月），96%的患者完成了超声心动图随访（平均52±37个月）。
无住院死亡或早期再次手术。8年时的总生存率为94%±6%，95%的患者纽约心脏协会心功能分级为Ⅱ级或更低。3例患者（4%）因二尖瓣再狭窄需要再次手术，2例接受了再次修复。在8年的随访中，免于心脏死亡和二尖瓣再次手术的比例分别为98%±2%和94%±5%。5年和10年时免于瓣膜相关事件的比例分别为90%±8%和86%±11%，5年时免于严重二尖瓣反流的比例为98%±2%，8年时为83%±9%。
一种更积极的切除病变瓣膜组织并随后进行重建的方法是可行的，中期效果良好，可能会扩大风湿性疾病患者瓣膜修复的范围。
