Schaff Hartzell Vernon, Nguyen Anita
Department of Cardiovascular Surgery, Mayo Clinic, 200 1st Street SW, Rochester, MN 55905 USA.
Indian J Thorac Cardiovasc Surg. 2020 Jan;36(Suppl 1):18-26. doi: 10.1007/s12055-019-00801-6. Epub 2019 Mar 26.
Mitral valve repair for patients with degenerative or functional mitral valve regurgitation improves symptoms and prognosis, and several techniques have been described. Important principles in operation are simplicity, reproducibility, and durability of repair. At Mayo Clinic, we have operated on more than 6000 patients with degenerative mitral valve disease and valve prolapse, and this review details our approach to mitral valve repair, including robotic and minimally invasive techniques. Most patients with isolated leaflet prolapse can be managed with leaflet plication or triangular resection, and chordal replacement is reserved for repair of anterior leaflet prolapse. Posterior annuloplasty with a standard-sized flexible band is used to reduce annular circumference and improve leaflet coaptation. With these methods, early risk of mortality for mitral valve repair is low in the current era (< 1%), and rate of recurrent valve leakage is 1.5 per 100 patient-years during the first year post-repair and 0.9 per 100 patient-years thereafter. This paper also briefly summarizes important considerations for patients with mitral valve regurgitation and severe calcification, perforations due to endocarditis, and rheumatic heart disease.
对于退行性或功能性二尖瓣反流患者，二尖瓣修复可改善症状并预后，已有多种技术被描述。手术的重要原则是修复的简单性、可重复性和耐久性。在梅奥诊所，我们已为6000多名患有退行性二尖瓣疾病和瓣膜脱垂的患者进行了手术，本综述详细介绍了我们的二尖瓣修复方法，包括机器人手术和微创技术。大多数单纯瓣叶脱垂患者可通过瓣叶折叠或三角形切除进行处理，腱索置换则用于修复前叶脱垂。使用标准尺寸的柔性带进行后瓣环成形术以减小瓣环周长并改善瓣叶对合。采用这些方法，在当前时代二尖瓣修复的早期死亡率较低（<1%），修复后第一年瓣膜反流复发率为每100患者年1.5次，此后为每100患者年0.9次。本文还简要总结了二尖瓣反流合并严重钙化、感染性心内膜炎所致穿孔以及风湿性心脏病患者的重要注意事项。
