Department of Cardiothoracic Surgery, National Heart Institute, Kuala Lumpur, Malaysia.
Eur J Cardiothorac Surg. 2013 Oct;44(4):673-81. doi: 10.1093/ejcts/ezt093. Epub 2013 Feb 27.
Contemporary experience with mitral valve (MV) repair in the rheumatic population is limited. We aimed to examine the long-term outcomes of rheumatic MV repair, to identify the predictors of durability and to compare the repair for rheumatic and degenerative MVs.
MV repairs for both rheumatic and degenerative lesions were analysed prospectively from our valve-repair registry. The primary outcomes investigated were mortality, survival, freedom from reoperation and freedom from valve failure. Logistic and Cox regression analyses were performed to define the predictors of reoperation and valve failure.
Between 1997 and 2010, 627 consecutive rheumatic MV repairs were performed (46.7% of all mitral repair procedures). The mean age of our study group was 32 ± 19 (range 3-75 years). In-hospital mortality was 2.4% and late mortality was 0.3%. Freedoms from reoperation for rheumatics at 5 and 10 years were 91.8 ± 4.8 and 87.3 ± 3.9%, respectively, comparable with that for degenerative valves at 92.0 ± 1.7 and 91.8 ± 4.8%, respectively (P = 0.79). Freedoms from valve failure for rheumatics at 5 and 10 years were 85.6 ± 2.3 and 72.8 ± 4.6%, respectively, whereas those for degenerative repairs were 88.7 ± 5.1 and 82.4 ± 7.7%, respectively (P = 0.45). Independent predictors for reoperation and valve failure in rheumatic patients were residual mitral regurgitation >2+ and performance of commissurotomy.
The durability of MV repair for rheumatic disease in the current era has improved and is comparable with the outstanding durability of repairs for degenerative disease. Modifications of standard repair techniques, adherence to the importance of good leaflet coaptation and strict quality control with stringent use of intraoperative transoesophageal echocardiography have all contributed to the improved long-term results.
目前有关风湿性人群二尖瓣（MV）修复的经验有限。本研究旨在研究风湿性 MV 修复的长期结果，确定其耐久性的预测因素，并比较风湿性和退行性 MV 的修复。
前瞻性地从我们的瓣膜修复登记处分析了风湿性和退行性病变的 MV 修复。研究的主要结果是死亡率、存活率、免于再次手术和免于瓣膜失效。进行逻辑和 Cox 回归分析以确定再次手术和瓣膜失效的预测因素。
1997 年至 2010 年，共进行了 627 例连续风湿性 MV 修复（占所有二尖瓣修复手术的 46.7%）。本研究组的平均年龄为 32±19 岁（年龄 3-75 岁）。住院死亡率为 2.4%，晚期死亡率为 0.3%。风湿性患者的 5 年和 10 年免于再次手术的比例分别为 91.8±4.8%和 87.3±3.9%，与退行性瓣膜的 92.0±1.7%和 91.8±4.8%相当（P=0.79）。风湿性患者的 5 年和 10 年免于瓣膜失效的比例分别为 85.6±2.3%和 72.8±4.6%，退行性修复的比例分别为 88.7±5.1%和 82.4±7.7%（P=0.45）。风湿性患者再次手术和瓣膜失效的独立预测因素是残余二尖瓣反流>2+和行交界切开术。
风湿性疾病二尖瓣修复的耐久性在当前时代得到了改善，与退行性疾病修复的出色耐久性相当。标准修复技术的改进、坚持良好瓣叶对合的重要性以及严格的质量控制，包括术中经食管超声心动图的严格使用，都有助于改善长期结果。
