Stevens Louis-Mathieu, Basmadjian Arsène-Joseph, Bouchard Denis, El-Hamamsy Ismaïl, Demers Philippe, Carrier Michel, Perrault Louis P, Cartier Raymond, Pellerin Michel
Department of Surgery, Montreal Heart Institute and Université de Montréal, Montreal, Quebec, Canada.
J Card Surg. 2010 Jan-Feb;25(1):9-15. doi: 10.1111/j.1540-8191.2009.00897.x. Epub 2009 Sep 2.
Mitral valve repair is the procedure of choice for severe degenerative mitral regurgitation (MR). The objective of this study was to review prospectively gathered echocardiographic and clinical results with mitral valve repair for degenerative disease.
Between May 1995 and July 2004, 403 patients underwent mitral valve repair for degenerative disease (mean age 63 +/- 12 years, 72% males). Concomitant procedures included CABG (29%), radiofrequency left-sided maze procedure (8%), aortic valve replacement (6%), and tricuspid valve repair (4%).
Thirty-day mortality was 0.4% for patients with isolated mitral valve repair and 5.1% for patients with mitral valve repair and concomitant procedure (p = 0.003). Five-year survival was higher for isolated mitral valve repair compared to mitral valve repair with a combined procedure (92 +/- 2% vs. 76 +/- 5%; p < 0.001). Pulmonary artery pressure and left atrial and left ventricular end-diastolic diameters were significantly improved following mitral valve repair (all p <or= 0.005) and this was sustained afterward. The freedom from severe (3+ or 4+) and moderate-severe (2+, 3+, or 4+) MR was 95% and 77% at 5 years, respectively, whereas the freedom from reoperation was 96 +/- 1% at 5 years. Significant predictors of moderate-severe MR recurrence were cardiac dilatation, anterior leaflet prolapse, and concomitant procedure, whereas mitral valve disease amenable to posterior leaflet resection had a lower risk of MR recurrence.
Excellent clinical outcomes can be obtained using standard techniques of mitral valve repair of the degenerative valve. MR recurrence is low but nonnegligible, emphasizing the necessity for long-term postoperative echocardiographic follow-up in these patients.
二尖瓣修复术是重度退行性二尖瓣反流（MR）的首选治疗方法。本研究的目的是前瞻性地回顾二尖瓣修复术治疗退行性疾病的超声心动图和临床结果。
1995年5月至2004年7月期间，403例患者接受了退行性疾病二尖瓣修复术（平均年龄63±12岁，72%为男性）。同期手术包括冠状动脉旁路移植术（CABG，29%）、射频左侧迷宫手术（8%）、主动脉瓣置换术（6%）和三尖瓣修复术（4%）。
单纯二尖瓣修复术患者的30天死亡率为0.4%，二尖瓣修复术联合同期手术患者的30天死亡率为5.1%（p = 0.003）。与二尖瓣修复术联合同期手术相比，单纯二尖瓣修复术患者的5年生存率更高（92±2%对76±5%；p < 0.001）。二尖瓣修复术后肺动脉压、左心房和左心室舒张末期直径均显著改善（均p≤0.005），且术后持续改善。5年时重度（3+或4+）和中重度（2+、3+或4+）MR的无复发率分别为95%和77%，而5年时再次手术的无复发率为96±1%。中重度MR复发的显著预测因素包括心脏扩大、前叶脱垂和同期手术，而适合后叶切除的二尖瓣疾病MR复发风险较低。
采用标准技术对退行性瓣膜进行二尖瓣修复可获得良好的临床结果。MR复发率较低但不可忽视，强调了对这些患者进行术后长期超声心动图随访的必要性。
