Department of Cardiothoracic Surgery, Baylor College of Medicine/Texas Heart Institute, Houston, Texas; Division of Cardiothoracic Surgery, Michael E. DeBakey Veterans Affairs Hospital, Houston, Texas.
Department of Cardiothoracic Surgery, Baylor College of Medicine/Texas Heart Institute, Houston, Texas.
Semin Thorac Cardiovasc Surg. 2019 Autumn;31(3):434-441. doi: 10.1053/j.semtcvs.2019.02.028. Epub 2019 Mar 5.
Between 2000 and 2008, the mitral valve (MV) repair rate in patients with severe mitral regurgitation at our low-volume Veterans Affairs hospital was 21%. After instituting a multidisciplinary valve team in 2009, we determined whether this rate increased and characterized the outcomes of patients with degenerative disease. We retrospectively reviewed data from 103 MV operations performed at our hospital between 1/2009 and 8/2016. MV pathology was categorized as degenerative, rheumatic, endocarditis, ischemic, hypertrophic cardiomyopathy, or failed prior MV repair. The surgical techniques used for MV repair were reviewed. For the patients with degenerative disease who underwent MV repair, we assessed leaflet involvement and postoperative valve function. For the full cohort, the MV repair rate was 67% and the 30-day mortality rate was 0.97%. Of the 74 patients with degenerative disease, 64 (86.5%) underwent MV repair (none required reoperation). For these patients, the MV repair rate was significantly higher when the surgical approach was sternotomy rather than minimally invasive right minithoracotomy (92.5% vs 71.4%, P = 0.03). After MV repair, 95.3% of the degenerative disease patients had mild or less mitral regurgitation; median echocardiography follow-up time was 555 days. Anatomic features associated with a reduced MV repair rate in patients with degenerative disease were dystrophic leaflet calcification and severe mitral annular calcification. In an institution with a low volume of MV operations, preoperative surgical planning with a multidisciplinary valve team was associated with improved MV repair rates and excellent repair quality in patients with degenerative valve disease.
2000 年至 2008 年期间，在我们低容量退伍军人事务医院中，患有严重二尖瓣反流的患者二尖瓣修复率为 21%。2009 年成立多学科瓣膜团队后，我们确定了这一比例是否增加，并对退行性疾病患者的结局进行了特征描述。我们回顾性分析了 2009 年 1 月至 2016 年 8 月期间在我院进行的 103 例二尖瓣手术的数据。二尖瓣病理分为退行性、风湿性、心内膜炎、缺血性、肥厚型心肌病或先前二尖瓣修复失败。回顾了二尖瓣修复术所使用的外科技术。对于接受二尖瓣修复的退行性疾病患者，我们评估了瓣叶受累情况和术后瓣膜功能。对于整个队列，二尖瓣修复率为 67%，30 天死亡率为 0.97%。在 74 例退行性疾病患者中，64 例（86.5%）接受了二尖瓣修复术（无再次手术）。对于这些患者，胸骨切开术而非微创右小开胸术的手术方法，二尖瓣修复率显著更高（92.5%比 71.4%，P=0.03）。二尖瓣修复后，95.3%的退行性疾病患者的二尖瓣反流程度为轻度或更轻；中位数超声心动图随访时间为 555 天。退行性疾病患者二尖瓣修复率降低的相关解剖特征为营养不良性瓣叶钙化和严重二尖瓣环钙化。在二尖瓣手术量低的机构中，术前与多学科瓣膜团队进行手术规划与退行性瓣膜疾病患者的二尖瓣修复率提高和修复质量改善相关。
