van Leeuwen Wouter J, Head Stuart J, de Groot-de Laat Lotte E, Geleijnse Marcel L, Bogers Ad J J C, Van Herwerden Lex A, Kappetein A Pieter
Department of Cardiothoracic Surgery, Erasmus University Medical Centre, Rotterdam, Netherlands.
Interact Cardiovasc Thorac Surg. 2013 Jun;16(6):731-7. doi: 10.1093/icvts/ivt026. Epub 2013 Feb 26.
Guidelines recommend surgical mitral valve repair in selected patients with asymptomatic severe mitral valve regurgitation (MR), but the role of repair remains a matter of debate. Survival analyses of operated asymptomatic patients have been reported, but long-term haemodynamics and quality of life are not well defined. The aim of this study was to report the long-term follow-up focusing on these aspects.
Our database identified patients who underwent primary isolated mitral valve repair for severe MR and were asymptomatic by New York Heart Association Class I and in sinus rhythm. To obtain sufficient length of follow-up, only patients operated on before 2006 returned for an echocardiogram and quality-of-life assessment (SF-36).
Between May 1991 and December 2005, 46 asymptomatic patients with severe MR and a normal left ventricular function (ejection fraction >60%) were operated on. Mean age was 50.2 ± 13.2 years and 89% of patients were male. There were no operative deaths. Mean follow-up was 8.4 ± 3.9 years with 386 patient-years, survival was 93.3% at 12 years and comparable with the general age-matched Dutch population. Follow-up echocardiography showed that 92% had no to mild MR, and 3 patients had moderate MR. Left ventricular function was good/impaired/moderate in 66/29/5% of patients. Quality-of-life SF-36 assessment showed that mean physical and mental health components were 83 ± 17 and 79 ± 17, which was comparable with that of the general age- and gender-matched Dutch population.
Our experience shows that mitral valve repair for severe MR in asymptomatic patients is safe, and has satisfactory long-term survival with a low recurrence rate of MR, good left ventricular function, and excellent quality of life that is comparable with the general Dutch population.
指南推荐对部分无症状的重度二尖瓣反流（MR）患者进行二尖瓣手术修复，但修复的作用仍存在争议。已有关于接受手术的无症状患者的生存分析报道，但长期血流动力学和生活质量尚不明确。本研究的目的是报告针对这些方面的长期随访情况。
我们的数据库确定了因重度MR接受初次单纯二尖瓣修复且纽约心脏协会心功能分级为I级且处于窦性心律的无症状患者。为获得足够长的随访时间，仅2006年前接受手术的患者返回进行超声心动图检查和生活质量评估（SF - 36）。
1991年5月至2005年12月期间，46例无症状的重度MR且左心室功能正常（射血分数>60%）的患者接受了手术。平均年龄为50.2±13.2岁，89%的患者为男性。无手术死亡病例。平均随访时间为8.4±3.9年，共386患者年，12年生存率为93.3%，与年龄匹配的荷兰普通人群相当。随访超声心动图显示，92%的患者无至轻度MR，3例患者有中度MR。66%/29%/5%的患者左心室功能良好/受损/中度。生活质量SF - 36评估显示，平均身体和心理健康评分分别为83±17和79±17，与年龄和性别匹配的荷兰普通人群相当。
我们的经验表明，对无症状的重度MR患者进行二尖瓣修复是安全的，具有令人满意的长期生存率，MR复发率低，左心室功能良好，生活质量优异，与荷兰普通人群相当。
