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二尖瓣修复的耐久性:单中心经验

Durability of mitral valve repair: A single center experience.

作者信息

Salihi Salih, Güden Mustafa

机构信息

Department of Cardiovascular Surgery, Sakarya University Training and Research Hospital, Sakarya, Turkey.

Department of Cardiovascular Surgery, Mega Medipol Hospital, Istanbul, Turkey.

出版信息

Turk Gogus Kalp Damar Cerrahisi Derg. 2019 Oct 23;27(4):459-468. doi: 10.5606/tgkdc.dergisi.2019.18165. eCollection 2019 Oct.

Abstract

BACKGROUND

This study aims to present clinical outcomes of mitral valve repair in patients with different etiologies.

METHODS

Between June 2006 and August 2017, a total of 421 consecutive patients (266 males, 155 females; mean age 53.1±15.6 years; range, 5 to 89 years) who underwent mitral valve repair with or without concomitant cardiac procedures were retrospectively analyzed. All pre-, intra-, and postoperative data were collected. Echocardiographic examinations were performed at discharge and during follow-up. Kaplan-Meier analysis was used to estimate overall survival and from residual severe mitral regurgitation, endocarditis and reoperation-free survival rates.

RESULTS

The mean follow-up was 58.9±35.1 months. Of the patients, 12 (2.8%) had previous cardiac operations. The most predominant pathology was degenerative disease in 265 patients (62.9%). Repair techniques included ring annuloplasty (n=366, 86.9%), artificial chordae implantation (n=185, 44%), and commissurotomy (n=38, 9%). Overall in-hospital mortality rate was 1.2% (n=5). Echocardiography before discharge showed no/trivial mitral regurgitation in 64.9% (n=270) and mild mitral regurgitation in 34.85% (n=145) of the patients. At the late postoperative period, transthoracic echocardiography revealed moderate mitral regurgitation in 23 patients (5.7%) and severe in 11 patients (2.7%). The mean late survival and freedom from endocarditis, reoperation, and recurrent severe mitral regurgitation rates were 92±0.03%, 98.5±0.07%, 98.1±0.01%, and 94.7±0.02%, respectively.

CONCLUSION

Our study results suggest that mitral valve repair is a safe and effective procedure associated with favorable longterm outcomes in experienced centers.

摘要

背景

本研究旨在呈现不同病因患者二尖瓣修复的临床结果。

方法

回顾性分析2006年6月至2017年8月期间连续接受二尖瓣修复术(伴或不伴同期心脏手术)的421例患者(男性266例,女性155例;平均年龄53.1±15.6岁;范围5至89岁)。收集所有术前、术中和术后数据。出院时及随访期间进行超声心动图检查。采用Kaplan-Meier分析评估总生存率以及无残余严重二尖瓣反流、无感染性心内膜炎和无再次手术生存率。

结果

平均随访时间为58.9±35.1个月。患者中12例(2.8%)曾接受过心脏手术。最主要的病理类型为退行性病变,共265例(62.9%)。修复技术包括环缩成形术(n = 366,86.9%)、人工腱索植入术(n = 185,44%)和交界切开术(n = 38,9%)。总体住院死亡率为1.2%(n = 5)。出院前超声心动图显示64.9%(n = 270)的患者无/微量二尖瓣反流,34.85%(n = 145)的患者有轻度二尖瓣反流。术后晚期,经胸超声心动图显示23例患者(5.7%)有中度二尖瓣反流,11例患者(2.7%)有重度二尖瓣反流。晚期平均生存率以及无感染性心内膜炎、无再次手术和无复发性严重二尖瓣反流率分别为92±0.03%、98.5±0.07%、98.1±0.01%和94.7±0.02%。

结论

我们的研究结果表明,在经验丰富的中心,二尖瓣修复术是一种安全有效的手术,具有良好的长期效果。

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