Tabata Minoru, Kasegawa Hitoshi, Fukui Toshihiro, Shimizu Atsushi, Sato Yasunori, Takanashi Shuichiro
Department of Cardiovascular Surgery, Sakakibara Heart Institute, Tokyo, Japan.
Department of Cardiovascular Surgery, Sakakibara Heart Institute, Tokyo, Japan.
J Thorac Cardiovasc Surg. 2014 Nov;148(5):2033-2038.e1. doi: 10.1016/j.jtcvs.2014.03.045. Epub 2014 Mar 27.
Artificial chordal replacement has been shown to be effective and durable, with numerous techniques reported. However, the outcomes of each technique have remained poorly defined. We report the long-term outcomes of the tourniquet technique.
We reviewed the data from 700 patients who had undergone mitral valve repair with the tourniquet technique from 1992 to 2010. We analyzed the operative outcomes, long-term survival rate, freedom from reoperation, and freedom from recurrent moderate or severe mitral regurgitation (MR). We also performed Cox regression analysis to explore the predictors of recurrent MR after mitral valve repair using the tourniquet technique.
The mean age was 54.7±14.9 years; 212 patients (30.3%) had anterior leaflet prolapse, 142 (20.3%) had posterior leaflet prolapse, and 346 (49.4%) had bileaflet prolapse. Operative mortality was 1.3%. In 26 cases (3.7%), mitral valve repair was unsuccessful and was converted to replacement. Of those successfully repaired, the 12-year survival rate, freedom from mitral reoperation, freedom from recurrent moderate or severe MR, and freedom from recurrent leaflet prolapse was 85.9%, 88.7%, 72.3%, and 89.0%, respectively. The significant predictors of recurrent MR were anterior leaflet prolapse, age, New York Heart Association class III or IV, left ventricular end-systolic dimension, no annuloplasty ring or band, and postoperative residual mild or greater MR.
The tourniquet technique is a simple and effective method to repair leaflet prolapse, with a low incidence of recurrent prolapse. The incidence of recurrent MR was high in the anterior leaflet prolapse group. Age, no annuloplasty ring or band, and residual MR were strong predictors of recurrent MR.
人工腱索置换已被证明是有效且持久的，有多种技术被报道。然而，每种技术的结果仍未得到明确界定。我们报告止血带技术的长期结果。
我们回顾了1992年至2010年期间700例行二尖瓣修复止血带技术患者的数据。我们分析了手术结果、长期生存率、再次手术率以及无中度或重度二尖瓣反流（MR）的情况。我们还进行了Cox回归分析，以探讨使用止血带技术进行二尖瓣修复后复发性MR的预测因素。
平均年龄为54.7±14.9岁；212例患者（30.3%）有前叶脱垂，142例（20.3%）有后叶脱垂，346例（49.4%）有双叶脱垂。手术死亡率为1.3%。26例（3.7%）患者二尖瓣修复未成功，转为置换手术。成功修复的患者中，12年生存率、无二尖瓣再次手术率、无复发性中度或重度MR率以及无复发性叶脱垂率分别为85.9%、88.7%、72.3%和89.0%。复发性MR 的显著预测因素为前叶脱垂、年龄、纽约心脏协会心功能Ⅲ或Ⅳ级、左心室收缩末期内径、未使用瓣环成形环或带以及术后残留轻度或更严重的MR。
止血带技术是修复叶脱垂的一种简单有效的方法，复发性脱垂发生率低。前叶脱垂组复发性MR的发生率较高。年龄、未使用瓣环成形环或带以及残留MR是复发性MR的强预测因素。
