Noack Thilo, Kiefer Philipp, Vivell Nina, Sieg Franz, Marin-Cuartas Mateo, Leontyev Sergey, Holzhey David Michael, Garbade Jens, Pfannmueller Bettina, Davierwala Piroze, Misfeld Martin, Seeburger Joerg, Borger Michael Andrew
University Department of Cardiac Surgery, Heart Centre Leipzig, Leipzig, Germany.
Eur J Cardiothorac Surg. 2020 Feb 1;57(2):300-307. doi: 10.1093/ejcts/ezz219.
Mitral valve (MV) annuloplasty ring dehiscence with subsequent recurrent mitral regurgitation represents an unusual but challenging clinical problem. Incidence, localization and outcomes for this complication have not been well defined.
From 1996 to 2016, a total of 3478 patients underwent isolated MV repair with ring annuloplasty at the Leipzig Heart Centre. Of these patients, 57 (1.6%) underwent reoperation due to annuloplasty ring dehiscence. Echocardiographic data, operative and early postoperative characteristics as well as short- and long-term survival rates after MV reoperation were analysed.
Occurrences of ring dehiscence were acute (<30 days), early (≤1 year) and late (>1 year) in 44%, 33% and 23% of patients, respectively. Localization of annuloplasty ring dehiscence was found most frequently in the P3 segment (68%), followed by the P2 (51%) and the P1 segments (47%). The 30-day mortality rate and 1- and 5-year survival rates after MV reoperation were 2%, 89% and 74%, respectively. During reoperation, MV replacement was performed in 38 (67%) and MV re-repair in 19 (33%) patients.
Annuloplasty ring dehiscence is clinically less common, localized more frequently on the posterior annulus and occurs mostly acutely or early after MV repair. MV reoperation can be performed safely in such patients.
二尖瓣（MV）瓣环成形环裂开并随后出现复发性二尖瓣反流是一个不常见但具有挑战性的临床问题。这种并发症的发生率、定位和结果尚未明确界定。
1996年至2016年，共有3478例患者在莱比锡心脏中心接受了单纯MV修复及瓣环成形术。其中，57例（1.6%）因瓣环成形环裂开接受了再次手术。分析了超声心动图数据、手术及术后早期特征以及MV再次手术后的短期和长期生存率。
瓣环裂开的发生分别为急性（<30天）、早期（≤1年）和晚期（>1年），分别占患者的44%、33%和23%。瓣环成形环裂开最常发生在P3段（68%），其次是P2段（51%）和P1段（47%）。MV再次手术后的30天死亡率、1年和5年生存率分别为2%、89%和74%。再次手术期间，38例（67%）患者进行了MV置换，19例（33%）患者进行了MV再次修复。
瓣环成形环裂开在临床上较少见，更常发生在后瓣环，且大多在MV修复后急性或早期出现。此类患者可安全地进行MV再次手术。
