Kasegawa Hitoshi, Shimizu Atsushi, Fukui Toshihiro, Takanashi Shuichiro, Shimokawa Tomoki
Department of Cardiovascular Surgery, Sakakibara Heart Institute, Tokyo, Japan.
Department of Cardiac Surgery, International University of Health and Welfare Mita Hospital, Tokyo, Japan.
JTCVS Open. 2022 Apr 14;10:169-175. doi: 10.1016/j.xjon.2022.02.029. eCollection 2022 Jun.
We describe our method and results of mitral valve repair up to 20 years in a defined group of patients with mitral regurgitation caused by an extreme billowing and prolapsing valve.
An extreme billowing and prolapsing valve was defined by the presence of excess tissue on both leaflets and prolapse of 2 or more of the 3 segments of each leaflet. Among 1344 consecutive patients who underwent mitral valve repair for degenerative mitral regurgitation between 1991 and 2012 at the Sakakibara Heart Institute, 73 patients met our definition of an extreme billowing and prolapsing valve. From these 73 patients, 67 patients who underwent mitral valve repair based on the surgical strategy we developed in July 1996 were enrolled in this study. Our strategy of mitral valve repair for extreme billowing and prolapsing valves consists of (1) volume reduction of the leaflets, (2) physiologic remodeling annuloplasty for long anterior leaflet, and (3) wide usage of artificial chordae.
Mean age of the patients was 46.6 ± 12.9 years. There were no hospital deaths and 6 late deaths in this series. Kaplan-Meier survival at 10 years was 96.8 ± 2.2%. There were 2 reoperations. Cumulative incidence rate of mitral valve reoperation and moderate or severe mitral regurgitation at 10 years was 1.8 ± 1.8% and 11.2 ± 4.0%. Number of artificial chordal replacement was associated with decreased risk of recurrent moderate mitral regurgitation (hazard ratio, 0.60; = .03).
Long-term echo follow-up demonstrates good results of mitral valve repair for extreme billowing and prolapsing valves using our strategy.
我们描述了在一组因瓣膜极度膨出和脱垂导致二尖瓣反流的特定患者中，长达20年的二尖瓣修复方法及结果。
瓣膜极度膨出和脱垂的定义为两个瓣叶均存在多余组织，且每个瓣叶的三个节段中有两个或更多节段脱垂。在1991年至2012年期间于酒匂心脏研究所接受退行性二尖瓣反流二尖瓣修复术的1344例连续患者中，73例符合我们对瓣膜极度膨出和脱垂的定义。从这73例患者中，选取了67例根据我们于1996年7月制定的手术策略接受二尖瓣修复术的患者纳入本研究。我们针对瓣膜极度膨出和脱垂的二尖瓣修复策略包括：（1）瓣叶减容；（2）针对长前叶的生理性重塑瓣环成形术；（3）广泛使用人工腱索。
患者的平均年龄为46.6±12.9岁。本系列中无住院死亡病例，有6例晚期死亡。10年时的Kaplan-Meier生存率为96.8±2.2%。有2例再次手术。10年时二尖瓣再次手术以及中度或重度二尖瓣反流的累积发生率分别为1.8±1.8%和11.2±4.0%。人工腱索置换的数量与复发性中度二尖瓣反流风险降低相关（风险比，0.60；P = 0.03）。
长期超声心动图随访显示，采用我们的策略对瓣膜极度膨出和脱垂的二尖瓣进行修复，效果良好。
