Department of Cardiology, Showa University Koto Toyosu Hospital.
Department of Cardiovascular Surgery, Showa University Koto Toyosu Hospital.
Circ J. 2019 Feb 25;83(3):567-575. doi: 10.1253/circj.CJ-18-0849. Epub 2019 Feb 9.
The ideal surgical technique for ischemic mitral regurgitation (MR) is controversial. We introduced an extended posterior mitral leaflet (PML) augmentation technique for functional MR with severe tethering, which detached the PML from the annulus almost completely and augmented it with a large 3×6-cm oval pericardial patch.
A total of 17 mitral repairs using the new technique were performed for ischemic MR with no 30-day mortality and 2 hospital deaths. The NYHA class was III in 47% and IV in 13%. The EuroSCORE II was 9.7±4.9. The ring size was 32±1.4 mm. Concomitant coronary bypass was performed in 67% and left ventricular repair in 28%. The mechanism of leaflet closure was evaluated using transthoracic echocardiography in 15 survivors. MR decreased to none or trivial with a significant increase in coaptation length (Pre: 4.6±0.8 mm vs. Post: 9.8±2.5 mm; P<0.001). The PML flexibly moved forward and tightly contacted as if "snuggling up" to the anterior leaflet. There were no late deaths, heart failure readmissions or MR recurrences during follow-up (850±181 days). All patients remained in NYHA I or II.
Extended PML augmentation for ischemic MR showed excellent early results with deep leaflet coaptation through a "snuggling up" phenomenon, which would help prevent late MR recurrence.
缺血性二尖瓣反流（MR）的理想手术技术仍存在争议。我们引入了一种扩展的后二尖瓣叶（PML）增强技术，用于严重牵连的功能性 MR，该技术几乎完全将 PML 从瓣环上分离，并使用一个 3×6 厘米的椭圆形心包补片进行增强。
共对 17 例缺血性 MR 患者进行了 17 例采用新技术的二尖瓣修复手术，术后 30 天内无死亡，2 例院内死亡。纽约心脏病协会（NYHA）心功能分级 III 级占 47%，IV 级占 13%。欧洲心脏手术风险评分 II（EuroSCORE II）为 9.7±4.9。瓣环大小为 32±1.4 毫米。67%的患者同时进行了冠状动脉旁路移植术，28%的患者进行了左心室修复术。15 例存活患者采用经胸超声心动图评估瓣叶关闭机制。MR 减少至无或轻度，且对合长度显著增加（术前：4.6±0.8 毫米 vs. 术后：9.8±2.5 毫米；P<0.001）。PML 灵活地向前移动并紧密接触，就像“依偎”在前瓣上一样。随访期间（850±181 天）无晚期死亡、心力衰竭再入院或 MR 复发。所有患者仍处于 NYHA I 或 II 级。
缺血性 MR 的扩展 PML 增强术通过“依偎”现象实现了深叶对合，早期效果极佳，这有助于预防晚期 MR 复发。
