Urban M, Pirk J, Skalský I, Szárszoi O, Netuka I
Klinika Kardiovaskulární chirurgie IKEM Praha.
Rozhl Chir. 2011 Feb;90(2):95-101.
We retrospectively analyzed long-term outcome of concomitant mitral valve repair and aortic valve replacement.
From 1996 to 2009 we performed mitral valve plasty with aortic valve replacement in 50 patients. Clinical and echocardiographic data were obtained from computer database and hospital records. Missing data were obtained through mailed questionnaire. We evaluated hospital mortality, long-term survival, thromboembolic and hemorrhagic complications and TR of 3+ on follow up echocardiography.
Four patients who had previously undergone aortic valve surgery were excluded from the study. Aortic valve pathology was stenosis in 21 patients, regurgitation in 20 and 4 patients presented with mixed aortic disease. The etiology of mitral regurgitation was rheumatic in 6, non-rheumatic in 31 and infective in 6 patients. Aortic valve was replaced with mechanical prosthesis in 22 (mean age 59) and tissue prosthesis in 24 (mean age 71) patients. Additional surgical procedure was performed in 26 patients. Follow-up was 94% complete, with a mean duration of 51 months. Hospital mortality was 13%. Two and five year survival was 79% and 64% respectively. We noted one case of retroperitoneal hemorrhage and one stroke. We recorded 9 (19.6%) patients with residual TR of more than 3+ grade on follow up echocardiography. Out of 9 patients with residual TR, 3 were operated for rheumatic and 6 for non-rheumatic mitral valve disease. One patients underwent successful mitral valve replacement with mechanical prosthesis, 3 died and 5 are treated expectantly.
We conclude that concomitant mitral valve repair with aortic valve replacement has high hospital mortality, excellent long-term survival and low complication rate. The durability of mitral valve repair in patients with rheumatic mitral valve disease is limited and replacement, rather that repair should be considered in this patient group.
我们回顾性分析了同期二尖瓣修复术和主动脉瓣置换术的长期疗效。
1996年至2009年，我们对50例患者进行了二尖瓣成形术并同期置换主动脉瓣。临床和超声心动图数据来自计算机数据库和医院记录。缺失数据通过邮寄问卷获取。我们评估了医院死亡率、长期生存率、血栓栓塞和出血并发症以及随访超声心动图检查发现的3级以上三尖瓣反流情况。
4例先前接受过主动脉瓣手术的患者被排除在研究之外。主动脉瓣病变中，21例为狭窄，20例为反流，4例为混合性主动脉疾病。二尖瓣反流的病因中，风湿性6例，非风湿性31例，感染性6例。22例（平均年龄59岁）患者置换了机械瓣膜，24例（平均年龄71岁）患者置换了生物瓣膜。26例患者还进行了其他手术操作。随访完成率为94%，平均随访时间为51个月。医院死亡率为13%。两年和五年生存率分别为79%和64%。我们注意到1例腹膜后出血和1例中风。随访超声心动图检查发现9例（19.6%）患者存在残余三尖瓣反流大于3级。在9例残余三尖瓣反流患者中，3例因风湿性二尖瓣疾病接受手术，6例因非风湿性二尖瓣疾病接受手术。1例患者成功置换了机械二尖瓣，3例死亡，5例接受保守治疗。
我们得出结论，同期二尖瓣修复术和主动脉瓣置换术的医院死亡率较高，长期生存率良好，并发症发生率较低。风湿性二尖瓣疾病患者二尖瓣修复术的耐久性有限，对于该患者群体应考虑进行置换而非修复。
