Department of Cardiovascular Surgery, German Heart Centre Munich, Technische Universität München, Munich, Germany.
Department of Cardiovascular Surgery, German Heart Centre Munich, Technische Universität München, Munich, Germany.
J Thorac Cardiovasc Surg. 2014 Jul;148(1):176-82. doi: 10.1016/j.jtcvs.2013.08.071. Epub 2013 Oct 28.
Undersized ring annuloplasty is the treatment of choice for functional mitral regurgitation. However, recurrence of mitral regurgitation within the first years is frequent. The aim of this study was to analyze the functional and clinical outcome after mitral valve repair with the 3-dimensional saddle-shaped Edwards GeoForm (Edwards Lifesciences LLC, Irvine, Calif) annuloplasty ring in patients with ischemic mitral regurgitation.
Between November 2006 and November 2012, 70 patients (mean age, 68 ± 10 years; mean left ventricular ejection fraction, 40% ± 15%) with functional mitral regurgitation due to ischemic cardiomyopathy underwent mitral valve repair with the Edwards GeoForm annuloplasty ring. Concomitant procedures, such as coronary artery bypass grafting (75.7%), tricuspid valve repair (25.7%), aortic valve replacement (8.6%), and the Maze procedure (4.3%), were performed in 92.9% of patients. Follow-up is 97% complete (mean, 3.0 ± 1.7 years). Transthoracic echocardiography was obtained 2.4 ± 1.7 years postoperatively.
Thirty-day mortality was 5.9%. Overall survival at 5 years was 71.3% ± 6.9%. At 4 years, overall freedom from recurrence of mitral regurgitation grade 3+ or greater was 92.5% ± 3.6%, and freedom from recurrence of mitral regurgitation grade 2+ or greater was 71.0% ± 8.7%. Three patients required a mitral valve-related reoperation for ring dehiscence. New York Heart Association functional class improved from 3.6 ± 0.6 to 1.6 ± 0.6 during follow-up (P < .05). Mean mitral valve pressure gradient was 3.3 ± 1.8 mm Hg across all ring sizes at the time of follow-up.
Mitral valve repair with the 3-dimensional saddle-shaped Edwards GeoForm annuloplasty ring in case of ischemic mitral regurgitation shows a low rate of recurrent regurgitation at 4 years. Clinically relevant mitral stenosis was not detected. The importance of secure anchoring of the device in the mitral annulus has to be emphasized to prevent ring dehiscence.
对于功能性二尖瓣反流，选择使用小环成形术是治疗方法。然而，在最初几年内，二尖瓣反流的复发较为频繁。本研究的目的是分析在缺血性二尖瓣反流患者中，使用 3D 鞍形 Edwards GeoForm（爱德华兹生命科学公司，加利福尼亚州欧文）瓣环进行二尖瓣修复后的功能和临床结果。
2006 年 11 月至 2012 年 11 月，70 例（平均年龄 68 ± 10 岁；平均左心室射血分数 40% ± 15%）因缺血性心肌病导致功能性二尖瓣反流的患者接受了使用 Edwards GeoForm 瓣环的二尖瓣修复术。在 92.9%的患者中同时进行了其他手术，如冠状动脉旁路移植术（75.7%）、三尖瓣修复术（25.7%）、主动脉瓣置换术（8.6%）和迷宫手术（4.3%）。随访率为 97%（平均 3.0 ± 1.7 年）。术后 2.4 ± 1.7 年进行经胸超声心动图检查。
30 天死亡率为 5.9%。5 年总生存率为 71.3% ± 6.9%。4 年时，总体二尖瓣反流分级 3+或以上的无复发率为 92.5% ± 3.6%，二尖瓣反流分级 2+或以上的无复发率为 71.0% ± 8.7%。3 例患者因环裂需要二尖瓣相关再手术。在随访期间，纽约心脏协会心功能分级从 3.6 ± 0.6 改善至 1.6 ± 0.6（P<.05）。所有环尺寸的平均二尖瓣瓣口压力梯度在随访时为 3.3 ± 1.8mmHg。
在缺血性二尖瓣反流患者中，使用 3D 鞍形 Edwards GeoForm 瓣环进行二尖瓣修复术，4 年时反流复发率较低。未发现有临床意义的二尖瓣狭窄。需要强调的是，为了防止环裂，装置在二尖瓣环中的固定必须安全可靠。
