Furukawa Hiroshi, Tamura Taishi, Honda Takeshi, Takiuchi Hiroki, Kuinose Masahiko, Tanemoto Kazuo
Department of Cardiovascular Surgery, Kawasaki Medical School, Kurashiki, Japan. Electronic correspondence:
Department of Cardiovascular Surgery, Kawasaki Medical School, Kurashiki, Japan.
J Heart Valve Dis. 2016 Nov;25(6):685-690.
An evaluation was made of the early clinical outcomes and efficacies of simple interrupted suturing (SIS) for redo mitral valve replacement (MVR).
Among 336 mitral valve surgery patients at the authors' institution between April 2000 and May 2014, a total of 21 redo MVR using SIS (12 women, nine men; mean age 67±11 years; range 32-80 years) participated in the study. Surgical indications for redo MVR were paravalvular leakage (PVL) in 10 patients, prosthetic valve endocarditis in five, mechanical valve thrombosis in three, and structural valve deterioration (SVD) of the bioprosthesis in three. The number of previous surgeries was one in 10 patients, two in seven, and three in four. With regards to surgical technique, sharp dissection was initially performed on one side of the previous prosthetic sewing cuff, and the overall sewing cuff was thereafter completely removed following leaflet detachment. SIS (mean number of sutures 32.5 ± 3.0; range: 28-40 sutures) was performed to implant the new prosthesis, without exposing the rough surface of the previous mitral valve annulus, thereby allowing for eventual implantation of the same-sized or larger-sized prosthesis.
The surgical procedure was successfully performed in all patients without any serious complications. Bioprostheses were selected for 11 patients, and mechanical valves for 10. Sixteen patients (76.2%) received a new prosthesis that was the same size as or larger than the previous prosthesis. Operative mortality within 30 days was 4.8%, which was similar to that of primary MVR in the same period (n = 83; 2.4%; p = 0.57). Recurrent PVL was detected in only one patient, who underwent a fourth surgery for SVD of the bioprosthesis.
SIS for redo MVR may allow for the implantation of larger prostheses, and this novel maneuver may achieve acceptable early clinical outcomes.
对再次二尖瓣置换术（MVR）采用单纯间断缝合（SIS）的早期临床结果和疗效进行评估。
在2000年4月至2014年5月作者所在机构的336例二尖瓣手术患者中，共有21例采用SIS的再次MVR患者（12例女性，9例男性；平均年龄67±11岁；范围32 - 80岁）参与研究。再次MVR的手术指征为：10例患者存在瓣周漏（PVL），5例为人工瓣膜心内膜炎，3例为机械瓣膜血栓形成，3例为生物瓣结构瓣膜退变（SVD）。既往手术次数：10例患者为1次，7例为2次，4例为3次。关于手术技术，最初在前次人工瓣膜缝合环的一侧进行锐性分离，然后在瓣叶分离后将整个缝合环完全切除。采用SIS（平均缝合针数32.5±3.0；范围：28 - 40针）植入新的人工瓣膜，不暴露前次二尖瓣环的粗糙表面，从而最终能够植入相同尺寸或更大尺寸的人工瓣膜。
所有患者手术均成功完成，无任何严重并发症。11例患者选用生物瓣，10例选用机械瓣。16例患者（76.2%）植入的新人工瓣膜与前次相同尺寸或更大。30天内手术死亡率为4.8%，与同期初次MVR的死亡率相似（n = 83；2.4%；p = 0.57）。仅1例患者检测到复发性PVL，该患者因生物瓣SVD接受了第四次手术。
再次MVR采用SIS可能允许植入更大的人工瓣膜，并且这种新方法可能取得可接受的早期临床结果。
