David Tirone E, David Carolyn M, Manlhiot Cedric
Division of Cardiovascular Surgery, Peter Munk Cardiac Centre, Toronto General Hospital and University of Toronto, Toronto, Ontario, Canada.
Division of Cardiovascular Surgery, Peter Munk Cardiac Centre, Toronto General Hospital and University of Toronto, Toronto, Ontario, Canada.
Ann Thorac Surg. 2014 Nov;98(5):1551-6. doi: 10.1016/j.athoracsur.2014.06.016. Epub 2014 Sep 4.
Sizing of annuloplasty rings and bands is variably based on intertrigonal or intercommissural distances or estimation of the anterior leaflet area. This study examines the results of mitral valve repair with Simplici-T annuloplasty band without predetermining its length in patients with mitral regurgitation (MR) as a result of degenerative disease.
Three hundred thirty-seven consecutive patients (median age, 58 years; 69% men) underwent mitral valve repair for MR as a result of degenerative disease (52% bileaflet prolapse and 36% anterior leaflet prolapse). Prolapse of the leaflet was corrected by chordal replacement with Gore-Tex sutures and occasionally a triangular resection. A posterior mitral annuloplasty with a Simplici-T band (median length, 70 mm; range, 52 to 80 mm) was performed by securing it from the lateral to the medial fibrous trigones. Annular reduction was performed selectively on the commissures, false commissures, and areas of posterior leaflet resection. Mitral valve function, gradients, and areas were assessed perioperatively and annually during a median follow-up of 4.1 years (interquartile range, 2.7 to 5.4 years) and was 98% complete.
There were 2 operative and 7 late deaths; survival at 5 years was 97.2%. Three patients were discharged from the hospital with mild to moderate MR, and during follow-up a total of 14 patients had MR greater than mild and 1 patient had MR greater than moderate. Mitral valve re-repair was performed in 1 patient who exhibited mitral stenosis. Freedom from MR greater than mild at 5 years was 93.3%.
Selective reduction of the mitral annulus with a posterior band without predetermining its length during mitral valve repair for degenerative MR provides excellent functional results.
瓣环成形环和带的尺寸确定方法各不相同，有的基于三角间或连合间距离，有的基于对前叶面积的估计。本研究探讨在患有退行性疾病导致二尖瓣反流（MR）的患者中，使用 Simplici-T 瓣环成形带进行二尖瓣修复且不预先确定其长度的结果。
337 例连续患者（中位年龄 58 岁；69%为男性）因退行性疾病接受二尖瓣反流的二尖瓣修复手术（52%为双叶脱垂，36%为前叶脱垂）。通过用 Gore-Tex 缝线进行腱索置换并偶尔进行三角形切除来纠正瓣叶脱垂。通过将 Simplici-T 带（中位长度 70 mm；范围 52 至 80 mm）从外侧纤维三角固定到内侧纤维三角，进行二尖瓣后瓣环成形术。在连合、假连合和后叶切除区域选择性地进行瓣环缩小。在中位随访 4.1 年（四分位间距 2.7 至 5.4 年）期间，对二尖瓣功能、梯度和面积进行围手术期和每年一次的评估，评估完成率为 98%。
有 2 例手术死亡和 7 例晚期死亡；5 年生存率为 97.2%。3 例患者出院时伴有轻度至中度 MR，在随访期间共有 14 例患者的 MR 大于轻度，1 例患者的 MR 大于中度。1 例出现二尖瓣狭窄的患者接受了二尖瓣再次修复。5 年时无大于轻度 MR 的自由度为 93.3%。
在因退行性 MR 进行二尖瓣修复时，使用后带选择性缩小二尖瓣瓣环且不预先确定其长度可提供出色的功能结果。
