Omay Oguz, Ozker Emre, Indelen Cenk, Baskurt Murat, Suzer Kaya, Gunay Ilhan
Department of Cardiovascular Surgery, Baskent University, Istanbul, Turkey.
Heart Surg Forum. 2009 Oct;12(5):E285-90. doi: 10.1532/HSF98.20091006.
Ischemic mitral regurgitation (IMR) is an important risk factor in coronary artery bypass grafting (CABG) operations. The decision to perform concomitant mitral annuloplasty along with the CABG depends on the surgeon's choice. The aim of this study was to evaluate the results of posterior annuloplasty procedures with autologous pericardium performed in patients with midadvanced and advanced functional ischemic mitral regurgitation.
Study participants were 36 patients with IMR (mean age 59 +/- 10 years) who underwent posterior pericardial annuloplasty and CABG operations between 2002 and 2007. Preoperative and postoperative (mean follow-up 18 +/- 1 months) MR grade, left atrium diameter, left ventricle end systolic diameter, left ventricle end diastolic diameter, left ventricle ejection fraction, and mitral valve gradients were measured with transthoracic echocardiography.
There was one late mortality (2, 8%) but none of the patients required reoperation for residual MR. We did not observe thromboembolism, bleeding, or infective endocarditis. The mean MR grade decreased from 3.4 +/- 0.5 to 0.5 +/- 0.6 (P < .01), left atrium diameter decreased from 45.3 +/- 5.5 mm to 43.2 +/- 3.8 mm (P < .01), left ventricle end diastolic diameter decreased from 53.2 +/- 5.6 mm to 50.9 +/- 5.5 mm (P < .01), and left ventricle end systolic diameter decreased from 39.7 +/- 5.8 mm to 34.6 +/- 6.5 mm (P < .01), whereas mean left ventricle ejection fraction increased from 37.9% +/- 6.1% to 43.7% +/- 7.3% (P < .01). In the late postoperative term, the functional capacity of the patients increased from mean New York Heart Association class 2.6 +/- 0.9 to 1.1 +/- 0.5. We did not observe any gradient in the mitral valve preoperatively in any patient, but in the follow-up, the mean gradient increased to 1.3 +/- 2.1 mmHg (P < .01).
Posterior pericardial annuloplasty with CABG in the treatment of IMR provides efficient mitral repair and significant decrease in the left atrium and left ventricle diameters, and provides a significant increase in left ventricular function. These results show IMR to be as effective as the other annuloplasty techniques. IMR is performed with autologous material and therefore does not entail any risk of complications from prosthetic material and is highly cost-effective.
缺血性二尖瓣反流（IMR）是冠状动脉旁路移植术（CABG）中的一个重要危险因素。是否在CABG的同时进行二尖瓣环成形术取决于外科医生的选择。本研究的目的是评估对中度和重度功能性缺血性二尖瓣反流患者采用自体心包进行后瓣环成形术的效果。
研究对象为36例IMR患者（平均年龄59±10岁），他们在2002年至2007年间接受了后心包瓣环成形术和CABG手术。术前及术后（平均随访18±1个月）通过经胸超声心动图测量二尖瓣反流（MR）分级、左心房直径、左心室收缩末期直径、左心室舒张末期直径、左心室射血分数和二尖瓣梯度。
有1例晚期死亡（2.8%），但无一例患者因残余MR需要再次手术。我们未观察到血栓栓塞、出血或感染性心内膜炎。平均MR分级从3.4±0.5降至0.5±0.6（P<.01），左心房直径从45.3±5.5mm降至43.2±3.8mm（P<.01），左心室舒张末期直径从53.2±5.6mm降至50.9±5.5mm（P<.01），左心室收缩末期直径从39.7±5.8mm降至34.6±6.5mm（P<.01），而平均左心室射血分数从37.9%±6.1%升至43.7%±7.3%（P<.01）。在术后晚期，患者的功能能力从平均纽约心脏协会（NYHA）分级2.6±0.9提高到1.1±0.5。术前所有患者二尖瓣均未观察到梯度，但在随访中，平均梯度升至1.3±2.1mmHg（P<.01）。
在IMR治疗中，CABG联合后心包瓣环成形术可有效修复二尖瓣，显著减小左心房和左心室直径，并显著提高左心室功能。这些结果表明IMR与其他瓣环成形术技术一样有效。IMR采用自体材料进行，因此不存在人工材料相关并发症的风险，且具有很高的成本效益。
