Drake Daniel H, Drake Charles G, Recchia Dino
Section of Cardiothoracic Surgery, Department of Surgery, Munson Medical Center, Traverse City, MI 49684, USA.
Interact Cardiovasc Thorac Surg. 2010 Feb;10(2):222-7. doi: 10.1510/icvts.2009.218214. Epub 2009 Nov 27.
Parabolic resection, named for the shape of the cut edges of the excised tissue, expands on a common 'trick' used by experienced mitral surgeons to preserve tissue and increase the probability of successful repair. Our objective was to describe and clinically analyze this simple modification of conventional resection. Thirty-six patients with mitral regurgitation underwent valve repair using parabolic resection in combination with other techniques. Institution specific mitral data, Society of Thoracic Surgeons data and preoperative, post-cardiopulmonary bypass (PCPB) and postoperative echocardiography data were collected and analyzed. Preoperative echocardiography demonstrated mitral regurgitation ranging from moderate to severe. PCPB transesophageal echocardiography demonstrated no regurgitation or mild regurgitation in all patients. Thirty-day surgical mortality was 2.8%. Serial echocardiograms demonstrated excellent repair stability. One patient (2.9%) with rheumatic disease progressed to moderate regurgitation 33 months following surgery. Echocardiography on all others demonstrated no or mild regurgitation at a mean follow-up of 22.8+/-12.8 months. No patient required mitral reintervention. Longitudinal analysis demonstrated 80% freedom from cardiac death, reintervention and greater than moderate regurgitation at four years following repair. Parabolic resection is a simple technique that can be very useful during complex mitral reconstruction. Early and intermediate echocardiographic studies demonstrate excellent results.
抛物线切除术因切除组织边缘的形状而得名，它是经验丰富的二尖瓣外科医生用于保留组织并提高成功修复概率的一种常见“技巧”的拓展。我们的目的是描述并临床分析这种对传统切除术的简单改良。36例二尖瓣反流患者接受了抛物线切除术联合其他技术的瓣膜修复术。收集并分析了机构特定的二尖瓣数据、胸外科医师协会数据以及术前、体外循环后（PCPB）和术后超声心动图数据。术前超声心动图显示二尖瓣反流程度从中度到重度不等。PCPB经食管超声心动图显示所有患者均无反流或仅有轻度反流。30天手术死亡率为2.8%。系列超声心动图显示修复稳定性极佳。1例（2.9%）风湿性疾病患者术后33个月进展为中度反流。其他所有患者在平均22.8±12.8个月的随访中超声心动图显示无反流或仅有轻度反流。无患者需要再次进行二尖瓣干预。纵向分析显示，修复术后四年，80%的患者免于心脏死亡、再次干预以及大于中度的反流。抛物线切除术是一种简单的技术，在复杂的二尖瓣重建中可能非常有用。早期和中期超声心动图研究显示效果极佳。
