Division of Cardiovascular Surgery, Temple University and Lewis Katz School of Medicine, Philadelphia, PA, USA.
Center for Biostatistics and Epidemiology, Department of Biomedical Education and Data Science, Temple University and Lewis Katz School of Medicine, Philadelphia, PA, USA.
Interact Cardiovasc Thorac Surg. 2022 Jul 9;35(2). doi: 10.1093/icvts/ivac144.
The aim of this study was to determine the long-term results of mitral valve (MV) repair with anterior leaflet patch augmentation.
Between 2012 and 2015, 45 patients underwent MV repair using the anterior leaflet patch augmentation technique at our institution. The mean age of the patients was 65.9 ± 13.0 years (16 males). We reviewed the MV pathology and the surgical techniques used and assessed the early and late results.
In terms of MV pathology, 43 patients (95.6%) had pure mitral regurgitation (MR) and 2 patients (4.4%) had mixed mitral stenosis and MR. Rheumatic changes were seen in 18 patients (40.0%). Postoperative echocardiography showed that 95.6% of patients had none to mild MR. During a median follow-up period of 5.5 years (range 0.1-8.3 years), there were 8 late deaths. Nine patients (20%) required reoperation. The mean interval between the initial operation and redo operation was 3.7 ± 3.1 years (range: 0.4-7.8 years). The causes of reoperation included patch dehiscence (n = 4), progression of mitral stenosis (n = 2), band dehiscence (n = 1), patch enlargement (n = 1) and unknown (n = 1). Eight patients underwent MV replacement and 1 underwent repeat MV repair. The freedom from reoperation at 3 and 5 years was 85.7 ± 6.7% and 81.2 ± 7.7%, respectively.
Anterior leaflet patch augmentation can provide excellent early results in the majority of the patients even in the presence of rheumatic pathology; however, we observed late reoperation in 20% of patients. Thus, this technique should be used with caution and careful follow-up with serial echocardiography is essential.
本研究旨在确定二尖瓣（MV）修复中使用前瓣叶补片增强的长期结果。
2012 年至 2015 年期间，我院 45 例患者采用前瓣叶补片增强技术行 MV 修复。患者的平均年龄为 65.9±13.0 岁（男 16 例）。我们回顾了 MV 病理和手术技术，并评估了早期和晚期结果。
就 MV 病理而言，43 例（95.6%）患者单纯性二尖瓣反流（MR），2 例（4.4%）患者混合性二尖瓣狭窄和 MR。18 例（40.0%）患者有风湿性改变。术后超声心动图显示 95.6%的患者无至轻度 MR。在 5.5 年（0.1-8.3 年）的中位随访期间，有 8 例患者死亡。9 例（20%）患者需要再次手术。首次手术和再次手术的平均间隔时间为 3.7±3.1 年（范围：0.4-7.8 年）。再次手术的原因包括补片裂开（n=4）、二尖瓣狭窄进展（n=2）、瓣环裂开（n=1）、补片扩大（n=1）和原因不明（n=1）。8 例患者行 MV 置换，1 例患者再次行 MV 修复。3 年和 5 年时无再次手术的生存率分别为 85.7±6.7%和 81.2±7.7%。
即使存在风湿性病变，前瓣叶补片增强在大多数患者中也能提供良好的早期结果；然而，我们观察到 20%的患者有晚期再次手术。因此，应谨慎使用该技术，且应进行连续超声心动图的仔细随访。
