Wang Z X, Zhuang X M, Zhang R, Tian Y K, Fu Q, Wei M X
Department of Cardiac Surgery, Fuwai Hospital Chinese Academy of Medical Sciences Shenzhen, Shenzhen 518057, China.
Department of Cardiovascular Surgery, Tianjin Medical University General Hospital, Tianjin 300052, China.
Zhonghua Yi Xue Za Zhi. 2020 May 12;100(18):1376-1379. doi: 10.3760/cma.j.cn112137-20191217-02756.
To evaluate the efficacy of coronary artery bypass grafting (CABG) surgery in left ventricular dysfunction patients complicated with different degrees of ischemic mitral regurgitation (IMR). The clinical data of 525 patients (428 males and 97 females) undergoing CABG in Fuwai Hospital Chinese Academy of Medical Sciences Shenzhen, and Tianjin Medical University General Hospital between January 2015 and December 2018 were collected. The average age was (61±7) years old. Among them, the patients with moderate to serve IMR and left ventricular ejection fraction(LVEF)≤40% were further selected, and the outcomes of CABG were analyzed. In total, 67 patients (48 males and 19 females) with moderate to severe IMR and LVEF≤40% were enrolled, among which 52 patients had moderate IMR, with a LVEF of 38%(35%, 40%). Transesophageal echocardiography (TEE) of 52 cases displayed no damage of papillary muscles, and ventricular wall motion was improved after CABG. Therefore, no treatment on the mitral valve was performed in this group. Six patients were with moderate-severe mitral insufficiency, with a LVEF of 38%(35%, 39%). After surgery, TEE found that the ventricular wall motion and regurgitation were improved, and the mitral valve structures were well. Thus, mitral valves were not treated in these patients. Nine patients were with severe mitral regurgitation, with a LVEF of 38%(35%, 39%). Two of them received valve repair because the papillary muscle function and the ring were well. Another 7 patients received valve replacements because the valve ring was dilatated and the leaflet was prolapsed. All patients recovered well. The LVEF increased significantly at 6 months after surgery [47%(45%, 48%) vs 38%(35%, 39%), 0.024], and the left ventricular end diastolic diameter also became smaller [57(56, 59) mm vs 61(59, 64) mm, 0.002]. For patients suffered from left ventricular dysfunction complicated with IMR, TEE is crucial to evaluate the valve function. To those with moderate-severe regurgitation, if papillary muscle function and the ring were seriously affected by ischemia, the valve replacement could facilitate the improvement of postoperative cardiac function.
评估冠状动脉旁路移植术（CABG）治疗合并不同程度缺血性二尖瓣反流（IMR）的左心室功能不全患者的疗效。收集了2015年1月至2018年12月在中国医学科学院阜外医院深圳医院、天津医科大学总医院接受CABG手术的525例患者（男性428例，女性97例）的临床资料。平均年龄为（61±7）岁。其中，进一步选取中度至重度IMR且左心室射血分数（LVEF）≤40%的患者，分析CABG的治疗效果。共有67例中度至重度IMR且LVEF≤40%的患者入组，其中52例为中度IMR，LVEF为38%（35%，40%）。52例患者经食管超声心动图（TEE）检查显示乳头肌无损伤，CABG术后室壁运动改善。因此，该组未对二尖瓣进行处理。6例为中重度二尖瓣关闭不全，LVEF为38%（35%，39%）。术后TEE检查发现室壁运动和反流改善，二尖瓣结构良好。因此，这些患者未对二尖瓣进行处理。9例为重度二尖瓣反流，LVEF为38%（35%，39%）。其中2例因乳头肌功能和瓣环良好接受瓣膜修复。另外7例因瓣环扩张和瓣叶脱垂接受瓣膜置换。所有患者恢复良好。术后6个月LVEF显著增加[47%（45%，48%）对38%（35%，39%），P=0.024]，左心室舒张末期内径也变小[57（56，59）mm对61（59，64）mm，P=0.002]。对于合并IMR的左心室功能不全患者，TEE对评估瓣膜功能至关重要。对于中重度反流患者，如果乳头肌功能和瓣环受缺血影响严重，瓣膜置换有助于改善术后心功能。
