Morisaki Akimasa, Takahashi Yosuke, Fujii Hiromichi, Sakon Yoshito, Murakami Takashi, Shibata Toshihiko
Department of Cardiovascular Surgery, Osaka City University Graduate School of Medicine, Osaka, Japan.
Department of Cardiovascular Surgery, Osaka City General Hospital, Osaka, Japan.
JTCVS Tech. 2020 May 16;3:110-121. doi: 10.1016/j.xjtc.2020.05.010. eCollection 2020 Sep.
We assessed the long-term outcomes of the loop technique with the ink-dot marking test, an alternative to the ink test for aligning the mitral valve (MV) leaflet height, during MV repair.
We retrospectively reviewed 351 patients who underwent MV repair with the loop technique via median sternotomy or right mini-thoracotomy. The ink-dot marking test involves creation of a dotted line between the rough and clear zones in the anterior leaflet and the center of the posterior leaflet by gentian violet. According to this marking, we adjusted the fixing position of the loops with or without the loop-in-loop technique and additional neochordal repair.
This study involved 141 women and 210 men (mean age, 63.7 ± 13.0 years). Forty-one patients required additional adjustment after the ink-dot marking test. No significant differences were found in the need for second arrest between patients who did and did not require additional adjustment after the ink-dot marking test (3 vs 32 patients, = .782). Predischarge transthoracic echocardiography showed trivial residual MV regurgitation (MR) in 285 patients, mild in 64, and moderate in 2. Ten patients needed reoperations (9 MV replacements and 1 MV re-repair) because of recurrent MR during postoperative follow-up. The 3-, 5-, and 10-year postoperative cumulative incidence of moderate to severe recurrent MR was 3.6%, 6.0%, and 19.8%, respectively.
The loop technique with the ink-dot marking test provided good early and long-term results. This test may help to decrease residual MR, especially when using the loop technique.
我们评估了在二尖瓣修复术中使用墨点标记试验的环技术的长期效果，墨点标记试验是一种用于调整二尖瓣（MV）瓣叶高度的替代墨染试验。
我们回顾性分析了351例通过正中胸骨切开术或右胸小切口采用环技术进行二尖瓣修复的患者。墨点标记试验是通过龙胆紫在前叶粗糙区和清晰区之间以及后叶中心之间绘制一条虚线。根据该标记，我们采用或不采用环中环技术及额外的新腱索修复来调整环的固定位置。
本研究纳入141例女性和210例男性（平均年龄63.7±13.0岁）。41例患者在墨点标记试验后需要额外调整。在墨点标记试验后需要和不需要额外调整的患者之间，二次心脏停搏的需求无显著差异（3例对32例，P = 0.782）。出院前经胸超声心动图显示，285例患者存在微量残余二尖瓣反流（MR），64例为轻度，2例为中度。10例患者因术后随访期间MR复发需要再次手术（9例二尖瓣置换和1例二尖瓣再次修复）。术后3年、5年和10年中度至重度复发性MR的累积发生率分别为3.6%、6.0%和19.8%。
采用墨点标记试验的环技术提供了良好的早期和长期效果。该试验可能有助于减少残余MR，尤其是在使用环技术时。
