Department of the Coronary Disease, Institute of Cardiology, Jagiellonian University, John Paul II Hospital, Pradnicka 80, Krakow, Poland.
Cardiol J. 2010;17(4):386-9.
Decreased left ventricle ejection fraction (LVEF) is a predictor of poor late outcome in patients with mitral regurgitation (MR). The relationship between pre-operative forward stroke volume (SV) and right heart parameters and perioperative outcome in patients with MR has been little studied.
Forty patients with severe organic MR, unsuitable for mitral valve repair, who underwent mitral valve replacement (MVR) were included in the study (50% men, average age 61 +/- 9 years). Exclusion criteria were: aortic valve disease, coronary artery disease, rethoracotomy, stroke, infection or significant perioperative bleeding. Pre-operative detailed echocardiographic examination was performed. The end-point was post-operative prolonged intensive care unit (ICU) stay of more than three days because of the need for inotropic support.
Pre-operative NYHA class was 2.6 +/- 0.4, mean right ventricular end-diastolic diameter (RVEDD) was 28.7 +/- 4 mm, TAPSE was 20 +/- 4 mm, mean right ventricular systolic pressure (RVSP) was 38 +/- 13 mm Hg, left ventricular end-systolic diameter was 43.5 +/- 11 mm, left ventricular end-diastolic diameter was 60 +/- 11 mm, left ventricular end-diastolic volume (Simpson) was 155 +/- 47 mL, LVEF was 55 +/- 11%, mean regurgitation fraction was 58% and forward SV (measured by Doppler) was 35 +/- +/- 11 mL. All patients survived the operation. Mean ICU stay was 3.2 +/- 2.9 days (range 1-10 days), mean TISS-28 was 623 +/- 293 and mean NEMS 151 +/- 85. By univariate analysis, ICU stay was significantly longer in patients in higher pre-operative NYHA (p = 0.04), lower LVEF (p = 0.01), lower forward SV (p = 0.001) higher RF (p = 0.01), pre-operative right ventricular dilatation (p = 0.04), higher RVSP (p = 0.006) and right ventricular dysfunction (p = 0.04). By multivariate analysis, forward SV (p = 0.002, b = -0.45) and RVEDD (p = 0.02, b = 0.31) were independent predictors for prolonged ICU stay.
Pre-operative forward stroke volume and right ventricle size are predictors of the perioperative hemodynamic status in patients with mitral regurgitation undergoing MVR.
左心室射血分数（LVEF）降低是二尖瓣反流（MR）患者预后不良的预测因素。MR 患者术前前向心排量（SV）与右心参数的关系及其与围手术期结局的关系尚未得到充分研究。
本研究纳入 40 例因二尖瓣反流严重且不适合二尖瓣修复而行二尖瓣置换术（MVR）的患者（50%为男性，平均年龄 61±9 岁）。排除标准为：主动脉瓣疾病、冠状动脉疾病、再次开胸手术、中风、感染或显著围手术期出血。术前进行详细的超声心动图检查。终点是术后因需要正性肌力支持而在重症监护病房（ICU）延长 3 天以上。
术前纽约心脏协会（NYHA）心功能分级为 2.6±0.4，平均右心室舒张末期直径（RVEDD）为 28.7±4mm，组织多普勒测的三尖瓣环收缩期位移（TAPSE）为 20±4mm，平均右心室收缩压（RVSP）为 38±13mmHg，左心室收缩末期直径为 43.5±11mm，左心室舒张末期直径为 60±11mm，左心室舒张末期容积（Simpson）为 155±47ml，LVEF 为 55±11%，平均反流分数为 58%，前向 SV（多普勒测量）为 35±11ml。所有患者均存活手术。平均 ICU 入住时间为 3.2±2.9 天（范围 1-10 天），平均 TISS-28 为 623±293，NEMS 为 151±85。单因素分析显示，术前 NYHA 心功能分级较高（p=0.04）、LVEF 较低（p=0.01）、前向 SV 较低（p=0.001）、反流分数较高（p=0.01）、术前右心室扩张（p=0.04）、RVSP 较高（p=0.006）和右心室功能障碍（p=0.04）的患者 ICU 入住时间明显更长。多因素分析显示，前向 SV（p=0.002，b=-0.45）和 RVEDD（p=0.02，b=0.31）是二尖瓣反流患者 MVR 术后围手术期血流动力学状态的独立预测因素。
术前前向心排量和右心室大小是二尖瓣反流患者行二尖瓣置换术围手术期血流动力学状态的预测因素。
