Galloway A C, Colvin S B, Baumann F G, Grossi E A, Ribakove G H, Harty S, Spencer F C
Department of Surgery, New York University Medical Center, New York 10016.
Ann Thorac Surg. 1989 May;47(5):655-62. doi: 10.1016/0003-4975(89)90113-6.
The continued good results after mitral valve reconstruction prompted this retrospective study to compare operative and late results from our institutional experience since 1976 with 975 porcine mitral valve replacements (MVRs) (1976 to December 1987), 169 mechanical MVRs (1976 to December 1987), and 280 Carpentier-type mitral valve reconstructions (CVRs) (1980 to mid-1988). The operative mortality was 2.0% for isolated CVR, 6.6% for isolated mechanical MVR, and 8.5% for isolated porcine MVR. The overall operative mortality was 5.0% for CVR, 16.6% for mechanical MVR, and 10.6% for porcine MVR. The overall 5-year survival including hospital deaths was 76% for CVR, 72% for mechanical MVR, and 69% for porcine MVR. By multivariate analysis, the predictors of increased operative risk and of decreased survival were age, New York Heart Association functional class IV status, previous cardiac operation, and performance of concomitant cardiac surgical procedures. The type of valvular procedure was not predictive of operative risk or overall survival. The 5-year freedom from reoperation was 94.4% for nonrheumatic patients having CVR, 77.4% for rheumatic patients having CVR, 96.4% for mechanical MVR, and 96.6% for porcine MVR (p less than 0.05, rheumatic patients with CVR versus both MVR groups). The 5-year freedom from all valve-related morbidity and mortality was significantly better for valve reconstruction compared with both types of valve replacement. Thus, the operative risk and late survival obtained after mitral valve reconstruction were at least equivalent to those obtained after MVR. In addition, patients receiving mitral valve reconstruction had less valve-related combined morbidity than patients receiving valve replacement, thus making mitral valve reconstruction preferable in some patients with mitral insufficiency.
二尖瓣重建术后持续良好的效果促使开展了这项回顾性研究，以比较自1976年以来我们机构的经验中975例猪二尖瓣置换术（MVR）（1976年至1987年12月）、169例机械二尖瓣置换术（1976年至1987年12月）以及280例Carpentier型二尖瓣重建术（CVR）（1980年至1988年年中）的手术及远期结果。单纯CVR的手术死亡率为2.0%，单纯机械MVR为6.6%，单纯猪MVR为8.5%。CVR的总体手术死亡率为5.0%，机械MVR为16.6%，猪MVR为10.6%。包括住院死亡病例在内，CVR的总体5年生存率为76%，机械MVR为72%，猪MVR为69%。多因素分析显示，手术风险增加和生存率降低的预测因素为年龄、纽约心脏协会心功能IV级状态、既往心脏手术以及同期心脏外科手术的实施情况。瓣膜手术类型并非手术风险或总体生存的预测因素。非风湿性患者行CVR的5年再次手术率为94.4%，风湿性患者行CVR为77.4%，机械MVR为96.4%，猪MVR为96.6%（p<0.05，风湿性患者行CVR与两个MVR组相比）。与两种瓣膜置换术相比，瓣膜重建术后5年无所有瓣膜相关发病率和死亡率的情况明显更好。因此，二尖瓣重建术后的手术风险和远期生存至少与二尖瓣置换术后相当。此外，接受二尖瓣重建的患者瓣膜相关合并症比接受瓣膜置换的患者少，因此在一些二尖瓣关闭不全患者中二尖瓣重建更可取。
