Steuer K, Papadopoulos N, Moritz A, Doss M
Abteilung für Thorax-, Herz- und Thorakale Gefäßchirurgie, Johann-Wolfgang-Goethe-Universität Frankfurt am Main, Theodor-Stern-Kai 7, 60590, Frankfurt am Main, Deutschland.
Herz. 2012 Jun;37(4):424-31. doi: 10.1007/s00059-011-3545-1. Epub 2011 Nov 19.
The aim of this study is the analysis of long-term results in patients with hemodynamically significant mitral valve disease due to extensive calcified mitral annulus who underwent decalcification and patch reconstruction.
Between 1996 and 2008 a total of 109 patients underwent surgery in the presence of extensive calcification, severe mitral insufficiency and mitral stenosis. The mean age of patients (65 women, 44 men) was 66.4±13.8 years. Mitral valve repair was performed in 53 patients (49%), while the remaining 56 patients (51%) received a mitral valve replacement. In all, 64 patients (59%) required concomitant surgery. The mean follow-up time was 96±48 months.
Inpatient and late mortality rates were 8.3% (nine patients) and 25.6% (28 patients), respectively. The actuarial survival rates at 5, 8 and 12 years were 88.1%, 76.2% and 66.1%. Echocardiographic follow-up demonstrated mitral insufficiency III in four patients (6%). No patients had mitral insufficiency IV. We observed a significant reduction in left atrium diameter, LVEDD as well as mean transvalvular gradient. Freedom from reoperation at 5 and 8 years was 96.4% and 91.8%, respectively. We found systemic hypertension, diabetes mellitus, age above 65 years, concomitant aortic valve replacement, concomitant procedures, chronic renal insufficiency and cardiac decompensation in the medical history as predictors for significantly increased early or late mortality.
The long-term results strongly suggest that en bloc decalcification and patch reconstruction of the mitral annulus can be safely undertaken in high-risk patients.
本研究旨在分析因广泛钙化二尖瓣环导致血流动力学显著的二尖瓣疾病患者接受脱钙及补片重建术后的长期结果。
1996年至2008年间，共有109例存在广泛钙化、严重二尖瓣反流及二尖瓣狭窄的患者接受了手术。患者平均年龄为66.4±13.8岁（女性65例，男性44例）。53例患者（49%）接受了二尖瓣修复，其余56例患者（51%）接受了二尖瓣置换。共有64例患者（59%）需要同期手术。平均随访时间为96±48个月。
住院死亡率和晚期死亡率分别为8.3%（9例患者）和25.6%（28例患者）。5年、8年和12年的精算生存率分别为88.1%、76.2%和66.1%。超声心动图随访显示4例患者（6%）存在二尖瓣反流III级。无患者存在二尖瓣反流IV级。我们观察到左心房直径、左心室舒张末期内径以及平均跨瓣压差均显著降低。5年和8年免于再次手术的比例分别为96.4%和91.8%。我们发现病史中的系统性高血压、糖尿病、年龄大于65岁、同期主动脉瓣置换、同期手术、慢性肾功能不全及心脏失代偿是早期或晚期死亡率显著增加的预测因素。
长期结果强烈提示，对于高危患者可安全地进行二尖瓣环整块脱钙及补片重建。
