Schmidt-Habelmann P, Civrny J, Meisner H, Paek S U, Struck E, Sebening F
Thorac Cardiovasc Surg. 1985 Feb;33(1):20-2. doi: 10.1055/s-2007-1014074.
From April 1974 through December 1982, 673 patients underwent surgery for isolated mitral valvular disease. Valve replacement was mandatory in 507 patients; of these, 255 received low-profile mechanical (mainly Björk-Shiley) prostheses and 252 bioprostheses. In 166 patients the mitral valve was amenable to reconstructive repair. This analysis is concerned exclusively with a subset of 127 patients, in whom open mitral commissurotomy was carried out (104 females and 23 males with a mean age at the time of operation of 45.5 years). There were 2 postoperative deaths, both due to intractable arrhythmias: one on the 4th postoperative day and one 6 years after surgery, giving a cardiac-related mortality of 1.5%. Thromboembolic complications were observed in 5 patients, none of whom developed permanent neurological deficits. There were 2 non-cardiac-related deaths: one of cancer and one of viral pneumonia. Mitral valve replacement was subsequently required in 2 patients at 2 and 7 years, respectively, after commissurotomy. Surgical intervention is pending for 2 further patients who appear likely to require valve replacement. Based on actuarial curves, the analysis of these results shows that, provided valvular morphology is suitable, open mitral commissurotomy is superior to valve replacement with respect to mortality rate and long-term survival.
从1974年4月至1982年12月，673例患者接受了单纯二尖瓣疾病的手术治疗。507例患者必须进行瓣膜置换；其中，255例接受了低轮廓机械瓣膜（主要是 Björk-Shiley 瓣膜），252例接受了生物瓣膜。166例患者的二尖瓣适合进行重建修复。本分析仅关注其中127例接受开放式二尖瓣交界切开术的患者（104例女性和23例男性，手术时的平均年龄为45.5岁）。术后有2例死亡，均因顽固性心律失常：1例于术后第4天死亡，1例于术后6年死亡，心脏相关死亡率为1.5%。5例患者出现血栓栓塞并发症，均未出现永久性神经功能缺损。有2例非心脏相关死亡：1例死于癌症，1例死于病毒性肺炎。二尖瓣交界切开术后分别有2例患者在2年和7年后需要进行二尖瓣置换。另外2例患者似乎可能需要瓣膜置换，手术干预尚未进行。根据精算曲线，对这些结果的分析表明，只要瓣膜形态合适，开放式二尖瓣交界切开术在死亡率和长期生存率方面优于瓣膜置换术。
