Cardiac Valve Center, Department of Cardiac Surgery, Beijing Anzhen Hospital, Capital Medical University-Beijing Institute of Heart Lung and Blood Vessel Diseases, Beijing, China.
Center of Cardiovascular Surgery, The People's Hospital of Huaiyin Jinan, Jinan, Shandong, China.
Tex Heart Inst J. 2022 Nov 1;49(6). doi: 10.14503/THIJ-21-7801.
Mitral valve stenosis (MS) is the primary pathologic feature of rheumatic mitral valve disease, and the complex repair affects its clinical outcome. This study aimed to examine the efficacy of the 4-step commisuroplasty "SCORe" procedure by assessing changes in the mobility of mitral valve leaflets and its clinical effects.
From September 1, 2018, to January 13, 2019, patients with MS who underwent mitral valve repair with the SCORe procedure in the study center were analyzed in this prospective study. Mitral valve structure was assessed by transthoracic echocardiography pre- and postoperatively as well as during follow-up.
In total, 60 consecutive patients were examined. In 56 patients (93.3%), mitral valve orifice area (MVOA) was less than 1.5 cm2, and mean (SD) MVOA for the whole cohort was 1.20 (0.34) cm2. The mobility of the anterior leaflet was improved (P < .001) during the cardiac cycle postsurgery, but that of the posterior leaflet was not (P = .591). The mean (SD) coaptation length was increased significantly from 6.69 (1.32) mm to 7.92 (1.24) mm (P < .001) postoperatively. Mean (SD) MVOAs increased to 2.24 (0.38) cm2 postoperatively (P < .001). During the 1-year follow-up, there were no deaths or reoperations. Follow-up echocardiography revealed minor or mild regurgitation in 98.3% of patients.
These findings demonstrated that the SCORe procedure can effectively improve the mobility of mitral leaflets and enlarge the valve orifice area in patients with rheumatic MS in China, with minimal complications and promising results.
二尖瓣狭窄（MS）是风湿性二尖瓣疾病的主要病理特征，复杂的修复会影响其临床结果。本研究旨在通过评估二尖瓣瓣叶活动度的变化及其临床效果，来检验四步式交界切开术（SCORe）的疗效。
自 2018 年 9 月 1 日至 2019 年 1 月 13 日，在研究中心接受 SCORe 手术修复的 MS 患者进行了这项前瞻性研究。手术前后以及随访期间，经胸超声心动图评估二尖瓣结构。
共检查了 60 例连续患者。在 56 例（93.3%）患者中，二尖瓣瓣口面积（MVOA）小于 1.5cm2，整个队列的平均（SD）MVOA 为 1.20（0.34）cm2。手术后期，前瓣叶的活动度得到改善（P<0.001），而后瓣叶的活动度则无变化（P=0.591）。瓣叶的平均（SD）对合长度从 6.69（1.32）mm 显著增加至 7.92（1.24）mm（P<0.001）。术后平均（SD）MVOA 增加至 2.24（0.38）cm2（P<0.001）。在 1 年随访期间，无死亡或再次手术。随访超声心动图显示 98.3%的患者存在轻微或轻度反流。
这些发现表明，SCORe 手术可以有效地改善中国风湿性 MS 患者二尖瓣瓣叶的活动度和扩大瓣口面积，手术并发症少，效果有前景。
