Tomšic Anton, Klautz Robert J M, van Brakel Thomas J, Ajmone Marsan Nina, Versteegh Michel I M, Palmen Meindert
Department of Cardiothoracic Surgery, Leiden University Medical Center, Leiden, Netherlands.
Department of Cardiology, Leiden University Medical Center, Leiden, Netherlands.
Interact Cardiovasc Thorac Surg. 2018 Jul 1;27(1):124-130. doi: 10.1093/icvts/ivy020.
Surgical correction of commissural mitral valve prolapse can be challenging. Several surgical techniques, including commissural closure, leaflet resection with sliding plasty and chordal replacement, remain commonly in use. Conversely, papillary muscle head repositioning remains uncommonly utilized for the treatment of commissural prolapse.
Between January 2003 and December 2015, 518 patients underwent primary mitral valve repair for severe degenerative mitral valve regurgitation at our institution. Among them, 116 patients had non-isolated commissural prolapse (14 anterolateral, 82 posteromedial and 20 bicommissural prolapse). Eighty-eight patients underwent papillary muscle head repositioning and presented the study cohort.
The mean patient age was 62.8 ± 12.5 years, and 32 (36%) patients were women. Postoperative echocardiography showed no residual mitral regurgitation in all but 1 (1%) patient in whom Grade 2+ regurgitation was seen. The freedom from late reintervention rates at 5 and 10 years were 96.1% [95% confidence interval (CI) 91.8-100%] and 92.7% (95% CI 86.4-99.0%), respectively. Upon reoperation, no recurrent commissural prolapse was observed. Echocardiographic follow-up demonstrated excellent valve repair durability. The freedom from Grade ≥2+ mitral regurgitation rates at 5 and 10 years were 92.6% (95% CI 86.3-98.9%) and 86.1% (95% CI 76.7-95.5%), respectively.
Papillary muscle head repositioning for the treatment of commissural mitral valve prolapse is a reproducible and reliable technique that provides excellent long-term results.
二尖瓣连合处脱垂的外科矫正可能具有挑战性。几种外科技术，包括连合处闭合、带滑行修补术的瓣叶切除和弦索置换，仍普遍使用。相反，乳头肌头部重新定位在治疗连合处脱垂中仍较少使用。
2003年1月至2015年12月期间，518例患者在我们机构接受了原发性二尖瓣修复术，用于治疗严重退行性二尖瓣反流。其中，116例患者存在非孤立性连合处脱垂（14例为前外侧、82例为后内侧和20例为双连合处脱垂）。88例患者接受了乳头肌头部重新定位，并构成了研究队列。
患者平均年龄为62.8±12.5岁，32例（36%）为女性。术后超声心动图显示，除1例（1%）患者出现2+级反流外，所有患者均无残余二尖瓣反流。5年和10年的免于再次干预率分别为96.1%[95%置信区间（CI）91.8 - 100%]和92.7%（95%CI 86.4 - 99.0%）。再次手术时，未观察到复发性连合处脱垂。超声心动图随访显示瓣膜修复耐久性良好。5年和10年的免于≥2+级二尖瓣反流率分别为92.6%（95%CI 86.3 - 98.9%）和86.1%（95%CI 76.7 - 95.5%）。
乳头肌头部重新定位治疗二尖瓣连合处脱垂是一种可重复且可靠的技术，可提供优异的长期效果。
