Shimokawa Tomoki, Kasegawa Hitoshi, Tabata Minoru, Fukui Toshihiro, Kin Hajime, Shimizu Atsushi, Uchimuro Tomoya, Zaikokuji Kenta, Takanashi Schuichiro
Department of Cardiovascular Surgery, Sakakibara Heart Institute, Tokyo, Japan.
Department of Cardiovascular Surgery, Teikyo University, Tokyo, Japan.
JTCVS Tech. 2024 Mar 6;25:55-62. doi: 10.1016/j.xjtc.2024.02.020. eCollection 2024 Jun.
The present study assessed the late results of the operation, which consisted of the construction of a stentless mitral valve using autologous pericardium and valve implantation.
Between 2011 and 2018, among 1617 consecutive patients who underwent mitral valve operation at our institution, 15 adult patients (0.9%) with unrepairable mitral valves who wished to avoid conventional mitral valve replacement underwent this operation. Ten patients (67%) had a history of valve repair. After discharge, patients were prospectively followed-up with a echocardiographic evaluation up to the end point. The mean follow-up term was 70.8 ± 42.5 months.
There were no hospital deaths or thromboembolic events and only 1 late noncardiac death. Intraoperative transesophageal echocardiography of all patients revealed no or trivial mitral regurgitation. Eight patients (53.3%) underwent redo valve replacement within 12 years. Except 1 late death, the postoperative course was divided into 3 groups depending on the occurrence of redo surgery, as follows: an early reoperation group (reoperation within 4 years; n = 4), a late reoperation group (reoperation after 4 years; n = 4), and a free from reoperation group (n = 6). The latest transthoracic echocardiographic examination performed 7.2 ± 2.9 years after the operation revealed the grade of mitral regurgitation to be none in 2 patients, mild in 2 patients, mild to moderate in 1 patients, and moderate in 1 patient in the free from reoperation group.
Despite the high incidence of reoperation, Normo operation can be a viable option during valve replacement, especially for young patients.
本研究评估了使用自体心包构建无支架二尖瓣并进行瓣膜植入手术的远期结果。
2011年至2018年间，在我院连续接受二尖瓣手术的1617例患者中，15例（0.9%）无法修复二尖瓣且希望避免传统二尖瓣置换术的成年患者接受了该手术。10例患者（67%）有瓣膜修复史。出院后，对患者进行前瞻性超声心动图评估直至终点。平均随访时间为70.8±42.5个月。
无住院死亡或血栓栓塞事件，仅1例晚期非心脏死亡。所有患者术中经食管超声心动图显示无二尖瓣反流或轻度二尖瓣反流。8例患者（53.3%）在12年内接受了再次瓣膜置换术。除1例晚期死亡外，根据再次手术的发生情况，术后病程分为3组，如下：早期再次手术组（4年内再次手术；n = 4），晚期再次手术组（4年后再次手术；n = 4），无再次手术组（n = 6）。术后7.2±2.9年进行的最新经胸超声心动图检查显示，无再次手术组中，2例患者二尖瓣反流程度为无，2例为轻度，1例为轻度至中度，1例为中度。
尽管再次手术发生率较高，但对于瓣膜置换术，尤其是年轻患者，正常手术仍是一种可行的选择。
