Department of Cardiothoracic-, Transplantation and Vascular Surgery, Hannover Medical School, Hannover, Germany.
Department of Cardiothoracic-, Transplantation and Vascular Surgery, Hannover Medical School, Hannover, Germany.
Semin Thorac Cardiovasc Surg. 2022 Summer;34(2):512-516. doi: 10.1053/j.semtcvs.2021.05.001. Epub 2021 Jun 2.
The edge-to-edge mitral valve repair technique, invented by Alfieri and colleagues, introduced valve repair as a treatment option for patients with complex diseases where standard annuloplasty and related repair techniques are insufficient, due to annular calcification and patient frailty. We retrospectively evaluated the results of a transaortic edge-to-edge mitral valve repair (Alfieri stitch) in high-risk patients who were undergoing aortic valve replacement. From February, 2012 to December, 2017, 43 patients underwent transaortic edge-to-edge mitral valve repair with concomitant aortic valve replacement at a single institution. Preoperative and postoperative echocardiograms were compared. Home telephone follow up was conducted and postoperative morbidity was examined, including the need for reoperation, stroke and cardiac arrhythmia. 30-day and long-term survival rates were also determined. Mitral regurgitation (MR) was graded semi-quantitatively as 0 (trace and/or none), mild (1), moderate (2) or moderate to severe (3-4). The patients were 74 ± 7.8 years old. 65% of the patients were male. Mean cardiopulmonary bypass time was 115 ± 37 minutes and mean cross-clamp time was 71 ± 23 minutes. There was a significant improvement in preoperative vs postoperative median MR grade (2 (IQR 2-3) vs 0 (IQR 0-1); P = 0.05). Follow-up transthoracic echocardiograms in 29 patients obtained at a median of 9 months' (range 3 - 19 months') and in 16 patients at a median of 34 months' postoperatively (range 21 - 53 months') showed mild (1 (IQR 1-2)) grade of mitral regurgitation. 30-day survival was 98%. Long term survival at 12 and 24 months' were 88% and 81% respectively. Mitral valve reoperation was conducted in 1 patient (2%), who was suffering of endocarditis. Stroke occurred in 2 patients (7%). Cardiac arrhythmia was observed in 15 patients (35%). 8 patients (19%) suffered from atrial fibrillation and 7 patients (16%) displayed atrioventricular blockage. 10 patients (23%) could be treated conservatively and 5 patients (12%) needed implantation of a pacemaker. Transaortic edge-to-edge mitral valve repair can be safely performed during aortic valve replacement in high-risk patients and improves even long-term MR grade. Postoperative cardiac arrhythmia occurs frequently. 66% of them could be treated successfully by conservative procedures.
经主动脉缘对缘二尖瓣修复术（Alfieri 缝合术）在高危患者主动脉瓣置换术中的应用。从 2012 年 2 月至 2017 年 12 月，在一家医院共对 43 例患者进行了经主动脉缘对缘二尖瓣修复术和同期主动脉瓣置换术。比较了术前和术后的超声心动图。进行了家庭电话随访，并检查了术后发病率，包括需要再次手术、中风和心律失常。还确定了 30 天和长期生存率。二尖瓣反流（MR）按半定量分级为 0（微量和/或无）、轻度（1）、中度（2）或中度至重度（3-4）。患者年龄为 74±7.8 岁。65%的患者为男性。平均体外循环时间为 115±37 分钟，平均阻断时间为 71±23 分钟。术前与术后中位数 MR 分级（2（IQR 2-3）比 0（IQR 0-1）；P=0.05）有显著改善。29 例患者的中位随访时间为术后 9 个月（范围 3-19 个月），16 例患者的中位随访时间为术后 34 个月（范围 21-53 个月），显示轻度（1（IQR 1-2））级二尖瓣反流。30 天生存率为 98%。12 个月和 24 个月的长期生存率分别为 88%和 81%。1 例患者（2%）因感染性心内膜炎而行二尖瓣再手术。2 例患者（7%）发生中风。15 例患者（35%）出现心律失常。8 例（19%）患者发生心房颤动，7 例（16%）患者出现房室传导阻滞。10 例（23%）患者经保守治疗，5 例（12%）患者需要植入起搏器。高危患者主动脉瓣置换术中行经主动脉缘对缘二尖瓣修复术是安全的，甚至可改善长期的 MR 分级。术后心律失常发生率较高，其中 66%可通过保守治疗成功。
