Ragnarsson Sigurdur, Sjögren Johan, Sanchez Ricardo, Wierup Per, Nozohoor Shahab
Department of Cardiothoracic Surgery, Anaesthesia and Intensive Care, Skane University Hospital, Lund University, Lund, Sweden
Department of Cardiothoracic Surgery, Anaesthesia and Intensive Care, Skane University Hospital, Lund University, Lund, Sweden.
Interact Cardiovasc Thorac Surg. 2014 Oct;19(4):577-83. doi: 10.1093/icvts/ivu225. Epub 2014 Jul 6.
Resection techniques are the established method for posterior mitral valve leaflet repair in degenerative mitral valve disease. However, implantation of expanded polytetrafluoroethylene (ePTFE) neochordae is gaining acceptance. The aim of this study was to compare the durability and clinical outcome following mitral valve repair using ePTFE neochordae or leaflet resection.
A retrospective study was conducted of 224 patients who had undergone isolated mitral valve repair for degenerative posterior mitral leaflet prolapse from 1998 to 2012 at two cardiothoracic centres, one in Sweden and one in Denmark. Follow-up was performed in February 2013 and was 100% complete for survival (1184 patient-years; mean 5.9 ± 3.9 years). Event rates were estimated with the Kaplan-Meier method.
The 30-day mortality rate was 0.5%. Repair was successful in 215 patients (96.0%). Leaflet resection was performed in 146 (72.6%), whereas 55 (27.4%) underwent ePTFE neochordae repair. All patients received an annuloplasty with a mean size of 33 ± 4 mm in the ePTFE group and 31 ± 3 mm in the resection group (P = 0.001). The 5-year survival rate was 98.2 ± 1.8% in the ePTFE group and 93.9 ± 2.1% in the resection group (P = 0.67). At 5 years, the rate of freedom from recurrent moderate or severe mitral regurgitation was 91.9 ± 5.5% in the ePTFE group and 95.8 ± 2.1% in the resection group (P = 0.20), and the rate of freedom from all-cause reoperation was 100% in the ePTFE group and 97.9 ± 1.2% in the resection group (P = 0.36).
ePTFE neochordae is noninferior to resection repair for posterior mitral leaflet prolapse. Both techniques have comparable early and mid-term postoperative outcomes with low mortality, and a low incidence of reoperation and recurrent mitral regurgitation.
在退行性二尖瓣疾病中，切除技术是二尖瓣后叶修复的既定方法。然而，植入膨体聚四氟乙烯（ePTFE）人工腱索正逐渐被接受。本研究的目的是比较使用ePTFE人工腱索或瓣叶切除进行二尖瓣修复后的耐久性和临床结果。
对1998年至2012年在瑞典和丹麦的两个心胸中心接受孤立性二尖瓣修复术治疗退行性二尖瓣后叶脱垂的224例患者进行了一项回顾性研究。2013年2月进行随访，生存率随访完整率为100%（1184患者年；平均5.9±3.9年）。采用Kaplan-Meier法估计事件发生率。
30天死亡率为0.5%。215例患者（96.0%）修复成功。146例（72.6%）进行了瓣叶切除，而55例（27.4%）接受了ePTFE人工腱索修复。所有患者均接受了瓣环成形术，ePTFE组平均尺寸为33±4mm，切除组为31±3mm（P = 0.001）。ePTFE组5年生存率为98.2±1.8%，切除组为93.9±2.1%（P = 0.67）。5年时，ePTFE组无中度或重度二尖瓣反流复发率为91.9±5.5%，切除组为95.8±2.1%（P = 0.20），ePTFE组全因再次手术率为100%，切除组为97.9±1.2%（P = 0.36）。
对于二尖瓣后叶脱垂，ePTFE人工腱索不劣于切除修复。两种技术在术后早期和中期结果相当，死亡率低，再次手术和二尖瓣反流复发率低。
