Steuer K, Papadopoulos N, Moritz A, Doss M
Abteilung für Herz-, Thorax- und Thorakale Gefässchirurgie, Johann-Wolfgang-Goethe-Universität Frankfurt am Main, Theodor-Stern-Kai 7, 60590 Frankfurt am Main, Deutschland.
Herz. 2012 Nov;37(7):762-9. doi: 10.1007/s00059-011-3576-7.
The aim of this study was the analysis of long-term results in patients with hemodynamically significant mitral valve disease due to extensively calcified mitral annulus who underwent decalcification and patch reconstruction.
Between 1996 and 2008 a total of 109 patients underwent surgery for extensive calcification and severe mitral insufficiency and mitral stenosis. The mean age of the patients (65 women and 44 men) was 66.4 ± 13.8 years. In 53 patients (49%) mitral valve repair was performed and the remaining 56 patients (51%) received a mitral valve replacement. Of the patients 64 (59%) required concomitant surgery. The mean follow up time was 96 ± 48 months.
The in-hospital and late mortality was 8.3% (9 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%, respectively. Echocardiographic follow-up presented a mitral insufficiency grade III in 4 patients (6%). None of the patients had a mitral insufficiency grade IV. A significant reduction of left atrium diameter, of the LVEDD as well as the mean transvalvular gradient was observed. Freedom from reoperation at 5 and 8 years was 96.4% and 91.8%, respectively. Systemic hypertension, diabetes mellitus, age older than 65 years, concomitant aortic valve replacement, concomitant procedures, chronic renal insufficiency and cardiac decompensation in the medical history were found to be 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.
本研究旨在分析因二尖瓣环广泛钙化而患有血流动力学显著二尖瓣疾病的患者，在接受脱钙和补片重建手术后的长期结果。
1996年至2008年间，共有109例患者因广泛钙化、严重二尖瓣关闭不全和二尖瓣狭窄接受手术。患者平均年龄为66.4±13.8岁（65名女性和44名男性）。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。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III级二尖瓣关闭不全。无患者存在IV级二尖瓣关闭不全。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%。发现系统性高血压、糖尿病、年龄大于65岁、同期主动脉瓣置换、同期手术、慢性肾功能不全以及病史中的心脏失代偿是早期或晚期死亡率显著增加的预测因素。
长期结果强烈表明，二尖瓣环整块脱钙和补片重建可在高危患者中安全进行。
