Department of Cardiac Surgery, San Raffaele University Hospital, Milan, Italy.
J Thorac Cardiovasc Surg. 2012 Nov;144(5):1019-24. doi: 10.1016/j.jtcvs.2012.07.034. Epub 2012 Aug 25.
The very long-term results of the double-orifice mitral valve repair are unknown. The aim of this study was to assess the late clinical and echocardiographic outcomes of this technique in patients with degenerative mitral regurgitation.
From 1993 to 2000, 174 patients with severe degenerative mitral regurgitation were treated with the double-orifice technique combined with ring annuloplasty. Mean age of patients was 52 ± 12.8 years, New York Heart Association class I or II was present in 71% of the patients, atrial fibrillation in 17.2%, and preoperative left ventricular ejection fraction was 59.5% ± 7.5%. Mitral regurgitation was due to anterior leaflet prolapse in 36 patients (20.6%), bileaflet prolapse in 128 (73.5%), and posterior leaflet prolapse in 10 patients (5.7%).
There were no hospital deaths. At hospital discharge, mitral regurgitation was absent or mild in 169 patients (97.1%) and moderate (2+/4+) in 5 patients (2.8%). Mitral stenosis requiring reoperation was detected in 1 patient (0.6%). Clinical and echocardiographic follow-up was 97.1% complete (mean length, 11.5 ± 2.53 years; median, 11.6 years; longest duration, 17.6 years). At 14 years, actuarial survival was 86.9% ± 3.37%, freedom from cardiac death was 95.8% ± 1.54%, and freedom from reoperation was 89.6 ± 2.51%. At the last echocardiographic examination, recurrence of mitral regurgitation ≥3+ was documented in 23 patients (23/169, 13.6%). Freedom from mitral regurgitation ≥3+ at 14 years was 83.8% ± 3.39%. The only predictor of recurrence of mitral regurgitation ≥3+ was residual mitral regurgitation greater than mild at hospital discharge (hazard ratio, 5.7; 95% confidence interval, 1.6-20.6; P = .007).
The double-orifice repair combined with ring annuloplasty provides very satisfactory long-term results in patients with degenerative mitral regurgitation in the setting of bileaflet and anterior leaflet prolapse.
双孔二尖瓣修复的长期结果尚不清楚。本研究旨在评估该技术在退行性二尖瓣反流患者中的晚期临床和超声心动图结果。
1993 年至 2000 年，174 例严重退行性二尖瓣反流患者采用双孔技术联合环形瓣环成形术治疗。患者平均年龄 52±12.8 岁，71%为纽约心脏协会心功能Ⅰ或Ⅱ级，17.2%为心房颤动，术前左心室射血分数为 59.5%±7.5%。二尖瓣反流的病因是前叶脱垂 36 例（20.6%），双叶脱垂 128 例（73.5%），后叶脱垂 10 例（5.7%）。
无院内死亡。出院时，169 例（97.1%）患者二尖瓣反流为无或轻度，5 例（2.8%）患者为中度（2+/4+）。1 例（0.6%）患者发现二尖瓣狭窄需再次手术。临床和超声心动图随访 97.1%完整（平均随访时间 11.5±2.53 年；中位数 11.6 年；最长随访时间 17.6 年）。14 年时，实际生存率为 86.9%±3.37%，无心脏死亡生存率为 95.8%±1.54%，无再次手术生存率为 89.6%±2.51%。最后一次超声心动图检查时，23 例（23/169，13.6%）患者记录到二尖瓣反流≥3+复发。14 年时无二尖瓣反流≥3+的生存率为 83.8%±3.39%。二尖瓣反流≥3+复发的唯一预测因素是出院时轻度以上的残余二尖瓣反流（危险比，5.7；95%置信区间，1.6-20.6；P=0.007）。
在双叶和前叶脱垂的退行性二尖瓣反流患者中，双孔修复联合环形瓣环成形术可获得非常满意的长期结果。
