Mihos Christos G, Santana Orlando, Lamelas Joseph
J Heart Valve Dis. 2014 Jan;23(1):91-6.
The study aim was to evaluate the safety and efficacy of a transaortic edge-to-edge mitral valve repair in patients undergoing aortic valve replacement (AVR) who were considered to be at high risk for double-valve surgery.
All patients deemed to be at high surgical risk for standard double-valve surgery, and who instead underwent AVR with transaortic edge-to-edge mitral valve repair between September 2008 and October 2012 at the authors' institution, were analyzed retrospectively. Intraoperative transesophageal and follow-up transthoracic echocardiography were performed to evaluate adequacy of the repair and to assess for any recurrence of mitral regurgitation (MR).
A total of 55 patients (mean age 78.4 +/- 8.4 years) was identified (45 minimally invasive, 10 median sternotomy). All patients were in NYHA class III-IV. The aortic valve lesion was classified as stenosis (n = 45), insufficiency (n = 6), or prosthetic valve insufficiency (n = 4), and the mitral valve lesion as functional (n = 16), degenerative calcification (n = 27), or rheumatic (n = 12). There were four deaths (7%). The median total hospital length of stay was 7 days (IQR 6-11 days). The median preoperative versus postoperative MR grade was moderate-to-severe (3+) (IQR 3-4+) versus 0 (IQR 0-1+) (p < 0.001). The median time to follow up echocardiography was 6.5 months (IQR 0.8-12 months). The median preoperative and postoperative versus follow up MR grades were 3+ (IQR 3-4+) versus 1+ (IQR 0-1+) (p < 0.001), and 0 (IQR 0-1+) versus 1+ (IQR 0-1+) (p = 0.004), respectively.
In high-risk patients undergoing AVR with grade 3-4+ MR, a transaortic edge-to-edge mitral valve repair may be a safe and effective alternative to conventional double-valve surgery. However, longer-term data are needed to verify this proposal.
本研究旨在评估经主动脉缘对缘二尖瓣修复术在接受主动脉瓣置换术（AVR）且被认为双瓣手术风险较高的患者中的安全性和有效性。
对2008年9月至2012年10月期间在作者所在机构接受AVR并同时行经主动脉缘对缘二尖瓣修复术、被认为标准双瓣手术手术风险较高的所有患者进行回顾性分析。术中行经食管超声心动图检查，术后进行经胸超声心动图检查，以评估修复的充分性，并评估二尖瓣反流（MR）是否复发。
共纳入55例患者（平均年龄78.4±8.4岁）（45例为微创，10例为正中胸骨切开术）。所有患者均为纽约心脏协会（NYHA）心功能Ⅲ-Ⅳ级。主动脉瓣病变分类为狭窄（n = 45）、关闭不全（n = 6）或人工瓣膜关闭不全（n = 4），二尖瓣病变分类为功能性（n = 16）、退行性钙化（n = 27）或风湿性（n = 12）。有4例死亡（7%）。中位总住院时间为7天（四分位间距6 - 11天）。术前与术后MR分级的中位数分别为中重度（3+）（四分位间距3 - 4+）和0（四分位间距0 - 1+）（p < 0.001）。随访超声心动图的中位时间为6.5个月（四分位间距0.8 - 12个月）。术前与术后及随访时MR分级的中位数分别为3+（四分位间距3 - 4+）对1+（四分位间距0 - 1+）（p < 0.001），以及0（四分位间距0 - 1+）对1+（四分位间距0 - 1+）（p = 0.004）。
在接受AVR且伴有3 - 4+级MR的高危患者中，经主动脉缘对缘二尖瓣修复术可能是传统双瓣手术的一种安全有效的替代方法。然而，需要长期数据来验证这一观点。
