Department of Cardiovascular Surgery, German Heart Center Munich, Clinic at the Technical University, Munich, Germany.
Ann Thorac Surg. 2010 Apr;89(4):1163-70; discussion 1170. doi: 10.1016/j.athoracsur.2009.12.057.
In the past, chordal replacement techniques with expanded polytetrafluoroethylene sutures have been primarily reserved for anterior leaflet pathology, whereas the more frequent posterior leaflet prolapse was treated by resection. This study reports midterm results of isolated posterior prolapse repair with chordal replacement without resection as opposed to the quadrangular resection.
An analysis was made of 397 consecutive patients who underwent mitral valve repair for isolated posterior leaflet prolapse between 2000 and 2007. Of them, 205 patients (52%) underwent quadrangular resection (group R, "resection") and 192 patients (48%) underwent a neochordal repair (group NR, "no resection"). The follow-up is 98% complete (mean follow-up of 383 survivors is 1.9+/-1.4 years).
Overall 30-day mortality was 1.0% (4 of 397). Ten patients (2.5%) died late. Actuarial survival at 4 years for group R and group NR was 94%+/-3% and 98%+/-1%, respectively (p=0.99). Ten patients (2.5%) required a mitral valve-related reoperation after an average of 1.9+/-2 months. Freedom from reoperation at 4 years was 96%+/-1% for group R and 99%+/-1% for group NR (p=0.08). Generally, in patients of group NR, a larger annuloplasty ring could be implanted (mean size 32+/-2.5 versus 30+/-2, p<0.001). At latest follow-up, 94% of the patients showed no or grade I regurgitation, with no difference between groups.
Repair of posterior mitral leaflet prolapse by chordal replacement is equally effective as classic quadrangular resection, permits the use of larger annuloplasty rings, offers a potentially more physiological repair with preserved leaflet mobility, and can be performed with excellent midterm results and a low incidence of reoperation.
过去，使用膨体聚四氟乙烯缝线进行腱索替换技术主要保留用于前瓣叶病变，而更常见的后瓣叶脱垂则通过切除来治疗。本研究报告了 2000 年至 2007 年间，397 例单纯性后瓣叶脱垂患者行二尖瓣修复术的中期结果，其中 205 例（52%）行四边形切除术（组 R，“切除”），192 例（48%）行新腱索修复术（组 NR，“无切除”）。随访率为 98%（383 例存活者的平均随访时间为 1.9+/-1.4 年）。
总的 30 天死亡率为 1.0%（397 例中的 4 例）。10 例（2.5%）患者晚期死亡。组 R 和组 NR 的 4 年生存率分别为 94%+/-3%和 98%+/-1%（p=0.99）。10 例（2.5%）患者在平均 1.9+/-2 个月后需要二尖瓣相关再手术。组 R 的 4 年无再手术率为 96%+/-1%，组 NR 为 99%+/-1%（p=0.08）。一般来说，在组 NR 的患者中，可以植入更大的瓣环成形环（平均尺寸 32+/-2.5 与 30+/-2，p<0.001）。在最近的随访中，94%的患者无或 I 级反流，两组间无差异。
通过腱索替换修复后瓣叶脱垂与经典四边形切除术同样有效，可以使用更大的瓣环成形环，提供具有保留瓣叶活动性的潜在更生理的修复，并具有极好的中期结果和较低的再手术发生率。
