Gosev Igor, Yammine Maroun, Leacche Marzia, McGurk Siobhan, Ivkovic Vladimir, D'Ambra Michael N, Cohn Lawrence H
1 Division of Cardiac Surgery, 2 Department of Anesthesiology, Preoperative and Pain Medicine, Brigham and Women's Hospital, Boston, MA, USA.
Ann Cardiothorac Surg. 2015 Sep;4(5):428-32. doi: 10.3978/j.issn.2225-319X.2014.12.07.
Posterior mitral valve leaflet prolapse due to degenerative mitral valve disease has been treated with tissue sparing repair techniques since 2002. The simplified foldoplasty technique effectively lowers the height of the redundant posterior leaflet and creates an optimal coaptation line for the anterior leaflet that results in excellent long term durability, freedom from reoperation, and return of functional status.
Patient demographics and in-hospital outcome data were extracted from electronic medical records of 229 patients, aged 60.6±13.7 years who underwent the procedure for mitral valve repair (MVR) involving the posterior leaflet from myxomatous disease between 2002 and 2014. Parametric analyses were performed on outcomes data, while long-term survival was assessed by Kaplan-Meier analyses.
Concomitant coronary bypass surgery was performed on 32/229 (14%) patients, the mean perfusion time was 119±40 min, and the mean cross clamp time was 86±31 min. Post-operative mortality was 2/229 (0.9%), reoperation for bleeding occurred in 4 (1.7%) and postoperative stroke in 4 (1.7%) patients. Long term follow up rate was 100% and the mean study follow-up duration was 6.8±2.3 years. Overall late mortality rate was 24/229 (14.9%), and mitral valve re-intervention was performed on 7 patients (4.3%). NYHA class III/IV and clinically significant MR at follow up were significantly lower compared to preoperative values (both P<0.001).
Our results encourage further use of this simple and effective technique in patients with isolated posterior leaflet prolapse.
自2002年以来，退行性二尖瓣疾病导致的二尖瓣后叶脱垂一直采用保留组织的修复技术进行治疗。简化的折叠成形术技术有效地降低了多余后叶的高度，并为前叶创造了最佳的对合线，从而带来出色的长期耐久性、无需再次手术以及功能状态的恢复。
从2002年至2014年期间接受二尖瓣修复术（MVR）治疗黏液瘤病累及后叶的229例患者（年龄60.6±13.7岁）的电子病历中提取患者人口统计学和住院结局数据。对结局数据进行参数分析，同时通过Kaplan-Meier分析评估长期生存率。
32/229例（14%）患者同时进行了冠状动脉搭桥手术，平均灌注时间为119±40分钟，平均阻断时间为86±31分钟。术后死亡率为2/229例（0.9%），4例（1.7%）患者因出血再次手术，4例（1.7%）患者发生术后中风。长期随访率为100%，平均研究随访时间为6.8±2.3年。总体晚期死亡率为24/229例（14.9%），7例患者（4.3%）进行了二尖瓣再次干预。与术前值相比，随访时纽约心脏协会（NYHA）III/IV级和临床显著的二尖瓣反流明显降低（均P<0.001）。
我们的结果鼓励在孤立性后叶脱垂患者中进一步应用这种简单有效的技术。
