用于慢性缺血性二尖瓣反流的限制性二尖瓣环成形术：柔性环与半刚性环的疗效比较
Restrictive mitral valve annuloplasty for chronic ischaemic mitral regurgitation: outcomes of flexible versus semi-rigid rings.
作者信息
Pang Philip Y K, Huang Ming Jie, Tan Teing Ee, Lim See Lim, Naik Madhava J, Chao Victor T T, Sin Yoong Kong, Lim Chong Hee, Chua Yeow Leng
机构信息
Department of Cardiothoracic Surgery, National Heart Centre Singapore, Singapore.
C H Lim Thoracic Cardiovascular Surgery, Mount Elizabeth Medical Centre, Singapore.
出版信息
J Thorac Dis. 2019 Dec;11(12):5096-5106. doi: 10.21037/jtd.2019.12.04.
BACKGROUND
Restrictive mitral annuloplasty is the mainstay of surgical correction of chronic ischaemic mitral regurgitation (CIMR). Long-term data on the various types of annuloplasty rings is limited. The aim of this study was to investigate the clinical and echocardiographic outcomes of restrictive mitral annuloplasty in patients with CIMR, comparing the use of flexible versus semi-rigid annuloplasty rings.
METHODS
A retrospective review was conducted for 133 patients with CIMR who underwent restrictive mitral annuloplasty at our institution between 1999 and 2015. Patient demographics and postoperative outcomes were analyzed.
RESULTS
Mean age was 61.9±9.2 years and 103 patients (77.4%) were male. All patients underwent coronary artery bypass grafting, with a mean of 3.3±0.8 grafts. Flexible rings was implanted in 39 patients (29.3%, group F) and semi-rigid rings in 94 (70.7%, group R). Preoperative New York Heart Association class was III/IV in 104 patients (78.2%). Mean preoperative left ventricular ejection fraction was 28.8%±10.2%. Preoperative mitral regurgitation was moderate in 51 patients (38.3%) and severe in 82 (61.7%). In-hospital mortality occurred in 11 patients (8.3%). Overall survival at 1, 5 and 10 years were, respectively, 86.4%, 69.7% and 45.9%. At 10 years, overall survival (group F 53.1%, group R 40.0%, P=0.330) and freedom from moderate to severe MR (group F 53.1%, group R 53.8%, P=0.725) did not differ significantly. Freedom from hospitalization for heart failure was 59.3%. Left ventricular reverse remodelling, defined as a reduction of left ventricular end-systolic volume index >15%, occurred more commonly in Group R (51.1%) compared to Group F (23.1%), P=0.003.
CONCLUSIONS
Restrictive mitral annuloplasty was associated with an operative mortality of 8.3%. Heart failure symptoms and significant MR recur in approximately 40% of patients after 10 years. Survival remained suboptimal and was not influenced by the type of annuloplasty ring.
背景
限制性二尖瓣环成形术是慢性缺血性二尖瓣反流（CIMR）外科矫正的主要方法。关于各种类型二尖瓣环成形术环的长期数据有限。本研究的目的是调查CIMR患者限制性二尖瓣环成形术的临床和超声心动图结果，比较使用柔性与半刚性二尖瓣环成形术环的情况。
方法
对1999年至2015年间在本机构接受限制性二尖瓣环成形术的133例CIMR患者进行回顾性研究。分析患者的人口统计学和术后结果。
结果
平均年龄为61.9±9.2岁，103例患者（77.4%）为男性。所有患者均接受冠状动脉旁路移植术，平均移植3.3±0.8根血管。39例患者（29.3%，F组）植入柔性环，94例患者（70.7%，R组）植入半刚性环。术前纽约心脏协会分级为III/IV级的患者有104例（78.2%）。术前平均左心室射血分数为28.8%±10.2%。术前二尖瓣反流中度的患者有51例（38.3%），重度的有82例（61.7%）。11例患者（8.3%）发生院内死亡。1年、5年和10年的总生存率分别为86.4%、69.7%和45.9%。10年时，总生存率（F组53.1%，R组40.0%，P = 0.330）和无中度至重度二尖瓣反流生存率（F组53.1%，R组53.8%，P = 0.725）无显著差异。因心力衰竭住院的无事件生存率为59.3%。左心室逆向重构定义为左心室收缩末期容积指数降低>15%，R组（51.1%）比F组（23.1%）更常见，P = 0.003。
结论
限制性二尖瓣环成形术的手术死亡率为8.3%。约40%的患者在10年后出现心力衰竭症状和显著的二尖瓣反流复发。生存率仍然不理想，且不受二尖瓣环成形术环类型的影响。
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