Division of Cardiac Surgery, Corrigan Minehan Heart Center, Massachusetts General Hospital, Boston, Massachusetts.
Division of Cardiology, Massachusetts General Hospital, Boston, Massachusetts.
Ann Thorac Surg. 2020 Feb;109(2):437-444. doi: 10.1016/j.athoracsur.2019.07.029. Epub 2019 Aug 29.
To review the efficacy of a minimally invasive surgical technique for mitral valve (MV) repair, we analyzed a nonresectional technique for degenerative mitral regurgitation.
A retrospective analysis was performed on 101 consecutive patients who underwent a minimally invasive MV repair for severe degenerative mitral regurgitation between 2014 and 2017. All patients underwent a right lateral minithoracotomy and femoral cannulation and were repaired by a nonresectional technique using neochord loop implantation and ring annuloplasty. Patients were followed with longitudinal echocardiograms.
The median age was 58 years (interquartile range [IQR], 49-64), and 31% were women. The procedure was successfully performed using a right minithoracotomy in all patients except for 1 who required an extended thoracotomy. A median of 4 neochords were placed. The median length was 16 mm (IQR, 14-18), and ring size was 34 mm (IQR, 32-36). Concomitant procedures included left atrial appendage exclusion in 10 patients (10%) and patent foramen ovale closure in 13 (13%). Median cardiopulmonary bypass time was 152 minutes (IQR, 142-164), and aortic cross-clamp time was 90 minutes (IQR, 81-98). Operative mortality was 0% and 1-year survival 100%. At 3 years freedom from recurrent at least moderate mitral regurgitation was 100%, and no patient required a valve-related reoperation. At 1 year the median left atrial diameter decreased by 15% (44 vs 37 mm, P < .001), the left ventricular end-diastolic diameter decreased by 14% (53 vs 46 mm, P < .001), and MV gradients remained low (3.1 vs 2.9 mmHg, P = .54).
Minimally invasive MV repair using a nonresectional technique can be performed for severe degenerative mitral regurgitation with a low complication rate, excellent durability, and promising left ventricular reverse remodeling.
为了评估二尖瓣（MV）修复的微创技术的疗效，我们对退行性二尖瓣关闭不全的非切除技术进行了回顾性分析。
对 2014 年至 2017 年间接受微创 MV 修复的 101 例严重退行性二尖瓣关闭不全患者进行回顾性分析。所有患者均接受右侧小开胸术和股动脉插管，并采用非切除技术通过植入新腱环和环形瓣环成形术进行修复。患者接受了纵向超声心动图检查。
中位年龄为 58 岁（四分位距 [IQR]，49-64），31%为女性。除 1 例患者需要扩大开胸术外，所有患者均成功通过右侧小开胸术完成手术。中位数放置 4 根新腱环。中位数长度为 16 毫米（IQR，14-18），环的大小为 34 毫米（IQR，32-36）。同时进行的手术包括 10 例（10%）左心耳切除和 13 例（13%）卵圆孔未闭关闭术。中位体外循环时间为 152 分钟（IQR，142-164），主动脉阻断时间为 90 分钟（IQR，81-98）。手术死亡率为 0%，1 年生存率为 100%。3 年时，至少中度二尖瓣反流复发的无复发率为 100%，无患者需要瓣膜相关再次手术。1 年时，中位左心房直径减少 15%（44 毫米比 37 毫米，P<0.001），左心室舒张末期直径减少 14%（53 毫米比 46 毫米，P<0.001），二尖瓣梯度仍较低（3.1 毫米汞柱比 2.9 毫米汞柱，P=0.54）。
采用非切除技术的微创 MV 修复可用于治疗严重退行性二尖瓣关闭不全，并发症发生率低，耐久性好，左心室逆重构效果有前景。
