Department of Cardiovascular Surgery, The Sakakibara Heart Institute of Okayama.
Department of Cardiovascular Surgery, Kawasaki Medical School General Medical Center.
Circ J. 2018 May 25;82(6):1705-1711. doi: 10.1253/circj.CJ-17-1319. Epub 2018 Apr 13.
Although minimally invasive mitral valve repair (MIMVR) is increasingly being performed, only a few clinical studies from Japanese institutions have been reported.
From 2006 to 2017, 387 consecutive patients (135 females, mean age 56±13 years) underwent an initial isolated MIMVR through a right minithoracotomy. The mitral etiology was degenerative in 348, functional in 22, and endocarditis in 13 cases. Repair techniques included leaflet resection/plication in 280, chordal reconstruction in 109, and annuloplasty alone in 24 patients, and concomitant procedures included tricuspid valve repair and atrial fibrillation ablation in 70 (18.1%) and 78 (20.2%), respectively. Hospital mortality rate was 0.26%; 2 patients (0.5%) required intraoperative conversion to a median sternotomy. Perioperative morbidity included stroke (1.3%), reoperation for bleeding (0.8%), prolonged ventilation (0.5%), and permanent pacemaker implantation (2.1%). The transfusion rate was 14.7% and median ventilation time was 4 hours. Overall 5-year survival was 96.9%. For patients with degenerative mitral regurgitation (MR), the 5-year freedom from reoperation or severe recurrent MR, and freedom from ≥moderate MR were 94.7% and 82.2%, respectively. Repair for anterior mitral leaflet prolapse and the initial 30 cases were associated with higher occurrence of recurrent MR.
MIMVR can be performed safely with low levels of mortality and morbidity, and provides sufficient repair durability. A learning curve exists in terms of repair durability, especially for anterior mitral leaflet repair.
虽然微创二尖瓣修复术（MIMVR）的应用越来越广泛，但仅有少数来自日本机构的临床研究报告。
2006 年至 2017 年，387 例连续患者（135 例女性，平均年龄 56±13 岁）通过右微创小切口行初次孤立性 MIMVR。二尖瓣病因分别为退行性变 348 例，功能性 22 例，心内膜炎 13 例。修复技术包括瓣叶切除/修补 280 例，腱索重建 109 例，单纯瓣环成形术 24 例，同期手术包括三尖瓣修复和房颤消融分别为 70 例（18.1%）和 78 例（20.2%）。院内死亡率为 0.26%；2 例（0.5%）患者需术中转为正中开胸。围手术期并发症包括卒中（1.3%）、出血再次手术（0.8%）、机械通气时间延长（0.5%）和永久性起搏器植入（2.1%）。输血率为 14.7%，机械通气时间中位数为 4 小时。总体 5 年生存率为 96.9%。对于退行性二尖瓣反流（MR）患者，5 年无再手术或严重复发性 MR 及无≥中度 MR 的生存率分别为 94.7%和 82.2%。前瓣叶脱垂和前 30 例修复与复发性 MR 发生率较高相关。
MIMVR 可安全进行，死亡率和发病率低，修复耐久性充足。修复耐久性存在学习曲线，特别是在前瓣叶修复方面。
