Calafiore Antonio Maria, Iacò Angela Lorena, Clemente Daniela, Refaie Reda, Romano Silvio, Asif Mahmood, Penco Maria, Di Mauro Michele
Department of Adult Cardiac Surgery, Prince Sultan Cardiac Center, Riyadh, Saudi Arabia.
Department of Cardiovascular Disease, University of L'Aquila, L'Aquila, Italy.
Int J Cardiol Heart Vessel. 2014 Mar 3;3:32-36. doi: 10.1016/j.ijchv.2014.02.002. eCollection 2014 Jun.
The proper treatment of chronic ischemic mitral regurgitation (CIMR) is still under evaluation. The different role of mitral valve repair (MVr) or mitral valve prosthesis insertion (MVPI) is still not defined.
From May 2009 to December 2011 167 patients with ejection fraction (EF) ≤ 40% had MV surgery for CIMR, MVr in 135 (80.8%) and MVPI in 32 (19.2%). Indication to MVPI was a MV coaptation depth > 10 mm. EF was lower (26 ± 7 vs 32 ± 6, p = 0.0000) in MVPI, whereas MR grade (3.6 ± 0.8 vs 2.7 ± 0.9, p = 0.0000), left ventricle dimensions (end diastolic, LVEDD, 62 ± 7 vs 57 ± 6 mm, p = 0.0001; end systolic, LVESD, 49 ± 8 vs 44 ± 8 mm, p = 0.0018), systolic pulmonary artery pressure (51 ± 22 vs 41 ± 16 mm Hg, p = 0.0037) and NYHA Class (3.6 ± 0.5 vs 2.8 ± 0.6, p = 0.0000) were higher.
In-hospital mortality was similar (3.1 vs 3.7%) as well as 3-year survival (86 ± 6 vs 88 ± 4) and survival in NYHA Class I/II (80 ± 5 vs 83 ± 4). One hundred thirty nine patients had an echocardiographic evaluation after a minimum of 4 months (13 ± 8). EF rose significantly in both groups (from 26 ± 7% to 30 ± 4%, p = 0.0122, and from 32 ± 6% to 35 ± 8%, p = 0.0018). LVESD reduced significantly in both groups (from 49 ± 8 to 43 ± 9 mm, p = 0.0109, and from 44 ± 8 to 41 ± 7 mm, p = 0.0033). MR grade was significantly lower in patients who had MVPI (0.1 ± 0.2 vs 0.3 ± 0.3, p = 0.0011).
With appropriate indications, MVPI is a safe procedure which provides similar results to MVr with lower MR return, even if addressed to patients with worse preoperative parameters.
慢性缺血性二尖瓣反流（CIMR）的恰当治疗仍在评估中。二尖瓣修复术（MVr）或二尖瓣人工瓣膜植入术（MVPI）的不同作用仍未明确。
2009年5月至2011年12月，167例射血分数（EF）≤40%的患者因CIMR接受了二尖瓣手术，其中135例（80.8%）接受MVr，32例（19.2%）接受MVPI。MVPI的指征为二尖瓣瓣叶对合深度>10mm。MVPI组患者的EF较低（26±7 vs 32±6，p = 0.0000），而二尖瓣反流（MR）分级（3.6±0.8 vs 2.7±0.9，p = 0.0000）、左心室尺寸（舒张末期，LVEDD，62±7 vs 57±6mm，p = 0.0001；收缩末期，LVESD，49±8 vs 44±8mm，p = 0.0018）、收缩期肺动脉压（51±22 vs 41±16mmHg，p = 0.0037）及纽约心脏协会（NYHA）心功能分级（3.6±0.5 vs 2.8±0.6，p = 0.0000）均较高。
住院死亡率相似（3.1% vs 3.7%），3年生存率也相似（86±6 vs 88±4），NYHA I/II级患者的生存率也相似（80±5 vs 83±4）。139例患者在至少4个月（13±8）后接受了超声心动图评估。两组患者的EF均显著升高（从26±7%升至30±4%，p = 0.0122；从32±6%升至35±8%，p = 0.0018）。两组患者的LVESD均显著降低（从49±8降至43±9mm，p = 0.0109；从44±8降至41±7mm，p = 0.0033）。接受MVPI的患者MR分级显著更低（0.1±0.2 vs 0.3±0.3，p = 0.0011）。
在有适当指征的情况下，MVPI是一种安全的手术，即使针对术前参数较差的患者，其效果与MVr相似，但二尖瓣反流复发率更低。
