Department of Cardiac Surgery, Paediatric Cardiac Surgery Center, State Key Laboratory of Cardiovascular Disease, National Center for Cardiovascular Disease, Fuwai Hospital, Chinese Academy of Medical Sciences, Peking Union Medical College, Beijing, PR China.
Department of Cardiac Surgery, Paediatric Cardiac Surgery Center, State Key Laboratory of Cardiovascular Disease, National Center for Cardiovascular Disease, Fuwai Hospital, Chinese Academy of Medical Sciences, Peking Union Medical College, Beijing, PR China.
Semin Thorac Cardiovasc Surg. 2020;32(4):1002-1012. doi: 10.1053/j.semtcvs.2020.05.029. Epub 2020 Jun 5.
To introduce a standardized strategy and reproducible procedures of mitral repair for mitral regurgitation in the pediatric population with leaflet plication as a principal technique. Consecutive patients who had undergone mitral repair by our standardized repair-oriented strategy in our institution from January 2016 to December 2019 were included retrospectively. The standardized repair strategy included 3-step inspections and repair from the subvalvular to leaflet, and then to the annular level. The main surgical techniques included chordae detachment, papillary muscle splitting, leaflet plication, and posterior annuloplasty. The indication for leaflet plication was that the distance between 2 adjacent chordae tendineae was greater than 4 mm. A total of 113 patients were enrolled. During 22.6-month (range, 2-50 months) follow-up period, primary endpoint was documented in 15 (13.3%) patients, including 1 (0.9%) death, 0 transplantation, and 14 (12.4%) functional mitral failure. Freedom form primary endpoints at 6 months, 1 year, and 3 years was 94.7%, 94.7%, and 82.3%, respectively. Significant independent predictors of functional mitral valve failure were younger age (hazard ratio [HR], 0.28; 95% confidence interval [CI], 0.04-0.72; P = 0.037) and ischemic mitral regurgitation (MR) (HR, 24.34; 95% CI, 4.52-47.33; P < 0.001). Leaflet plication was significantly associated with well-functioned mitral valve (HR, 7.42; 95% CI, 2.35-30.54; P = 0.004). Compared with nonischemic MR group, ischemic MR group was noted with higher occurrence of primary endpoint events (11/28 vs 4/85, P < 0.001). The short- to mid-term outcomes of standardized mitral repair technique with leaflet plication were favorable, among which, however, repair for mitral regurgitation with ischemic lesions is comparatively challenging.
为了介绍一种标准化的策略和可重复的手术程序，用于修复儿科人群中的二尖瓣反流，主要技术为瓣叶折叠。回顾性纳入 2016 年 1 月至 2019 年 12 月期间，在我院采用标准化修复策略进行二尖瓣修复的连续患者。标准化修复策略包括从瓣下到瓣叶再到瓣环的 3 步检查和修复。主要手术技术包括腱索切断、乳头肌劈开、瓣叶折叠和后瓣环成形术。瓣叶折叠的适应证为 2 个相邻腱索之间的距离大于 4mm。共纳入 113 例患者。在 22.6 个月（范围 2-50 个月）的随访期间，15 例（13.3%）患者记录到主要终点，包括 1 例（0.9%）死亡、0 例移植和 14 例（12.4%）功能性二尖瓣衰竭。6 个月、1 年和 3 年的主要终点无事件生存率分别为 94.7%、94.7%和 82.3%。功能性二尖瓣瓣膜衰竭的显著独立预测因素为年龄较小（风险比 [HR]，0.28；95%置信区间 [CI]，0.04-0.72；P=0.037）和缺血性二尖瓣反流（MR）（HR，24.34；95%CI，4.52-47.33；P<0.001）。瓣叶折叠与功能良好的二尖瓣显著相关（HR，7.42；95%CI，2.35-30.54；P=0.004）。与非缺血性 MR 组相比，缺血性 MR 组主要终点事件的发生率较高（11/28 与 4/85，P<0.001）。采用瓣叶折叠的标准化二尖瓣修复技术的短期至中期结果良好，但修复缺血性病变引起的二尖瓣反流具有挑战性。
