Ivanov Borko, Djordjevic Ilija, Eghbalzadeh Kaveh, Schlachtenberger Georg, Gerfer Stephen, Gaisendrees Christopher, Kuhn Elmar, Rahmanian Parwis, Sabashnikov Anton, Mader Navid, Wahlers Thorsten
Department of cardiothoracic surgery, University Hospital Cologne, Heart Centre Cologne, Cologne, Germany.
Perfusion. 2022 Apr;37(3):284-292. doi: 10.1177/0267659121998938. Epub 2021 Feb 26.
Atrioventricular groove disruption (AVGD) is a rare and severe complication of mitral valve surgery (MVS). Current literature is limited to several case reports and series. Our aim was to analyze outcomes of patients with AVGD after MVS from our tertiary cardiac surgery center.
Between June 2010 and January 2019, 18 patients suffering AVGD were identified in our institutional database and included in our retrospective observation. Preoperative, intraoperative and outcome data were analyzed using IBM SPSS Statistics. Late survival was estimated by using the Kaplan-Meier survival analysis.
The mean age of the study population was 76 ± 5 years. Most common indication for MVS was an isolated mitral valve insufficiency (67%). Severe annular calcification was present in four patients (22%). Majority of implanted valves were biological prosthesis (78%). Due to the location, 72% suffered type I rupture. External repair was performed in 94% of all patients. Second look operation in regard of excessive mediastinal hemorrhage was necessary in 67% of patients. Mean hospital stay of the presented collective was 13 ± 11 days with an intra-hospital mortality of 56%. Late follow-up was obtained in eight patients at an average of 3.1 (1.6-5.7) years postoperatively.
Mortality rates for AVGD after MVS are high. However, way of managing AVGD depends on the underlying type of rupture and should be evaluated in regard of the myocardial damage. Due to the rare occurrence, registry data might help to address more scientific value concerning therapeutic measures and outcomes of this severe complication.
房室沟破裂（AVGD）是二尖瓣手术（MVS）罕见且严重的并发症。目前的文献仅限于几例病例报告和系列研究。我们的目的是分析来自我们三级心脏外科中心的二尖瓣手术后发生房室沟破裂患者的预后情况。
2010年6月至2019年1月期间，在我们机构数据库中识别出18例发生房室沟破裂的患者，并纳入我们的回顾性观察研究。使用IBM SPSS Statistics软件分析术前、术中和预后数据。采用Kaplan-Meier生存分析评估晚期生存率。
研究人群的平均年龄为76±5岁。二尖瓣手术最常见的指征是单纯二尖瓣关闭不全（67%）。4例患者（22%）存在严重的瓣环钙化。植入的瓣膜大多数为生物假体（78%）。由于破裂位置，72%的患者发生I型破裂。94%的患者进行了外部修复。67%的患者因纵隔出血过多需要进行二次手术。该组患者的平均住院时间为13±11天，院内死亡率为56%。8例患者获得了晚期随访，平均随访时间为术后3.1（1.6 - 5.7）年。
二尖瓣手术后房室沟破裂的死亡率很高。然而，房室沟破裂的处理方式取决于潜在的破裂类型，应根据心肌损伤情况进行评估。由于这种情况罕见，登记数据可能有助于为这种严重并发症的治疗措施和预后提供更多科学价值。
