Shimokawa Tomoki, Kasegawa Hitoshi, Matsuyama Shigefumi, Seki Hiroshi, Manabe Susumu, Fukui Toshihiro, Morita Satoshi, Takanashi Shuichiro
Department of Cardiovascular Surgery, Sakakibara Heart Institute, Tokyo, Japan.
Ann Thorac Surg. 2009 Sep;88(3):733-9; discussion 739. doi: 10.1016/j.athoracsur.2009.05.033.
In patients with mitral endocarditis, reconstruction of the damaged mitral valve (MV) is still challenging, and its durability remains unknown. We evaluated the long-term outcomes of MV repair for mitral regurgitation (MR) in patients with infective endocarditis.
From 1991 to 2006, 633 patients had MV repair for MR caused by leaflet prolapse: 78 had endocarditis (active in 14, healed in 64) and 555 had degenerative disease. Durability was assessed by reoperation and recurrent MR.
The overall hospital mortality rate was 1.0% (endocarditis 0% vs degenerative 1.1%; p = 0.99). The 10-year survival and freedom from reoperation were 91.1 +/- 1.6% and 92.2 +/- 1.7%, respectively, with no differences between endocarditis and degenerative disease. Older age, New York Heart Association class III or IV, impaired ventricular function, and no use of annuloplasty were independent predictors of all-cause death. Freedom from moderate or severe MR was 99.8 +/- 0.2% at 2 weeks, 91.9 +/- 1.5% at 5 years, and 83.3 +/- 2.3% at 10 years, for all patients and did not differ between groups at 10 years (p = 0.388). Anterior leaflet prolapse, preoperative atrial fibrillation, and no annuloplasty were independent predictors of recurrent MR. In endocarditis patients, recurrent MR was mainly caused by leaflet thickening and calcification, but not by recurrence of endocarditis.
MV repair for endocarditis is associated with low operative mortality and morbidity, and its long-term durability is comparable with that of repair for degenerative disease. This study suggests that a degenerative process causes late failure after MV repair for endocarditis.
在二尖瓣心内膜炎患者中，受损二尖瓣（MV）的重建仍然具有挑战性，其耐久性尚不清楚。我们评估了感染性心内膜炎患者二尖瓣反流（MR）的二尖瓣修复长期结果。
1991年至2006年期间，633例因瓣叶脱垂导致MR的患者接受了二尖瓣修复：78例患有心内膜炎（14例为活动期，64例为愈合期），555例患有退行性疾病。通过再次手术和复发性MR评估耐久性。
总体医院死亡率为1.0%（心内膜炎为0%，退行性疾病为1.1%；p = 0.99）。10年生存率和免于再次手术率分别为91.1±1.6%和92.2±1.7%，心内膜炎和退行性疾病之间无差异。年龄较大、纽约心脏协会III或IV级、心室功能受损以及未使用瓣环成形术是全因死亡的独立预测因素。所有患者在术后2周时中度或重度MR的发生率为99.8±0.2%，5年时为91.9±1.5%，10年时为83.3±2.3%，10年时两组之间无差异（p = 0.388）。前叶脱垂、术前房颤和未进行瓣环成形术是复发性MR的独立预测因素。在心内膜炎患者中，复发性MR主要由瓣叶增厚和钙化引起，而非心内膜炎复发。
心内膜炎的二尖瓣修复手术死亡率和发病率较低，其长期耐久性与退行性疾病修复相当。本研究表明，退行性过程导致心内膜炎二尖瓣修复术后晚期失败。
