Department of Cardiothoracic Surgery, Mount Sinai Medical Center, New York, NY 10029, USA.
Heart. 2010 Dec;96(24):1964-7. doi: 10.1136/hrt.2010.199620. Epub 2010 Sep 20.
Valve repair, where feasible, rather than valve replacement is the guideline recommended treatment for severe mitral regurgitation. To characterise 'real-world' clinical practice data were reviewed on 12,255 mitral valve operations performed in the UK between 2004 and 2008, as reported in the 2009 UK Adult Cardiac Surgical Database Report. The data demonstrate a large variation in the use of mitral valve repair; while the national repair rate was 51%, this varied from 20% to 90% among different hospitals. Outcomes were worse in patients who had valve replacement as opposed to repair, including a higher risk of operative mortality and stroke, in all subgroups examined. Some patients were, by virtue of the hospitals they attend, therefore, less likely to survive and more likely to have complications, because of a low use of valve repair in those centres. Concentration of mitral valve surgery in designated regional reference centres should allow more equitable access to mitral valve repair.
对于严重二尖瓣反流，瓣膜修复（在可行的情况下）而非瓣膜置换是指南推荐的治疗方法。为了描述“真实世界”的临床实践数据，对 2004 年至 2008 年间在英国进行的 12255 例二尖瓣手术进行了回顾，这些数据报告在 2009 年英国成人心脏外科学数据库报告中。数据表明，二尖瓣修复的使用存在很大差异；尽管全国修复率为 51%，但不同医院的修复率从 20%到 90%不等。与修复相比，接受瓣膜置换的患者结局更差，包括手术死亡率和中风风险增加，所有检查的亚组均如此。由于这些中心瓣膜修复的使用率较低，一些患者（由于他们就诊的医院）因此不太可能存活，并且更有可能出现并发症。指定区域参考中心集中进行二尖瓣手术应允许更公平地获得二尖瓣修复。
