Kaneyuki Daisuke, Nakajima Hiroyuki, Asakura Toshihisa, Yoshitake Akihiro, Tokunaga Chiho, Tochii Masato, Hayashi Jun, Takazawa Akitoshi, Izumida Hiroaki, Iguchi Atsushi
Division of Cardiovascular Surgery, Saitama Medical University International Medical Center, 1397-1, Yamane, Hidaka-shi, Saitama, 350-1298, Japan.
J Cardiothorac Surg. 2019 Nov 27;14(1):205. doi: 10.1186/s13019-019-1035-3.
Good mid-term durability of mitral valve repair of bileaflet lesions has been reported; however, patients may develop failure during follow-up. This study assessed late outcomes and mechanisms of failure associated with mitral valve repair of bileaflet lesions.
Fifty-six patients (mean age 67 ± 12 years) underwent mitral valve repair of bileaflet lesions due to degenerative disease in 2011-2018. Mitral annuloplasty was added to all procedures except for 1 patient with annular calcification. Mitral valve lesions were identified by surgical inspection. Mean clinical and echocardiography follow-up occurred at 2.7 ± 2.1 and 2.5 ± 1.9 years, respectively.
Additional mitral valve repair techniques involved triangular resection (n = 15 patients), quadrangular resection with sliding plasty (n = 12), neochordoplasty (n = 52), and commissural plication (n = 26). Prolapse of ≥2 anterior and posterior leaflet scallops occurred in 22 (39%) and 30 (54%) patients, respectively. During follow-up, 10 (17.8%) patients developed moderate or severe mitral regurgitation. Whereas prolapse or tethering was observed early after neochordoplasty or quadrangular resection, recurrent regurgitation occurred late after commissural repair. Five-year freedom from recurrent moderate or severe mitral regurgitation rates was 71.1 ± 11.0%.
Seventeen percent of patients developed recurrent mitral regurgitation during follow-up. Repair failure in the early phase occurred owing to aggressive resection of the posterior mitral leaflet or maladjustment of the artificial neochordae. Recurrent mitral regurgitation might occur in the late phase even after acceptable commissural repair. A sequential approach may be useful to improve the quality of mitral valve repair in bileaflet lesions.
已有报道称二尖瓣双叶病变修复术具有良好的中期耐久性；然而，患者在随访期间可能会出现手术失败。本研究评估了二尖瓣双叶病变修复术的远期疗效及失败机制。
2011年至2018年期间，56例（平均年龄67±12岁）因退行性疾病接受二尖瓣双叶病变修复术的患者纳入研究。除1例有瓣环钙化的患者外，所有手术均加做二尖瓣环成形术。通过手术检查确定二尖瓣病变情况。平均临床随访和超声心动图随访时间分别为2.7±2.1年和2.5±1.9年。
额外的二尖瓣修复技术包括三角形切除（15例患者）、四边形切除并滑动成形术（12例）、新腱索成形术（52例）和交界折叠术（26例）。分别有22例（39%）和30例（54%）患者出现≥2个前叶和后叶扇贝样脱垂。随访期间，10例（17.8%）患者出现中度或重度二尖瓣反流。新腱索成形术或四边形切除术后早期可观察到脱垂或瓣叶缩短，交界修复术后晚期出现复发性反流。复发性中度或重度二尖瓣反流的5年无复流率为71.1±11.0%。
17%的患者在随访期间出现复发性二尖瓣反流。早期修复失败是由于二尖瓣后叶的过度切除或人工腱索调整不当。即使交界修复可接受，晚期仍可能出现复发性二尖瓣反流。序贯方法可能有助于提高二尖瓣双叶病变修复的质量。
