Cohn L H
Z Kardiol. 1985;74 Suppl 6:1-5.
The debate between reconstructive versus replacement operations for the diseased mitral valve has taken on new importance as the late results for survival, thromboembolic phenomena and incidence of reoperation from a variety of prosthetic and bioprosthetic cardiac valves have now become available. Three series of patients at the Brigham and Women's Hospital from 1972-84, representing 120 patients undergoing open mitral valve reconstruction for mitral stenosis, 348 patients undergoing mitral valve replacement for mitral stenosis, and 363 patients undergoing mitral valve replacement for mitral valve regurgitation are presented. The operative mortality in the reconstruction group was 0, there were 5 late deaths, all non-cardiac, 9 patients had a thromboembolism (1.8%/pt year), and 9 patients required reoperation (1.7%/pt year). For those who had mitral valve replacement for mitral stenosis the operative mortality was 10%, 6% for isolated replacement, 20% if this included a coronary artery bypass. At 9 years the long-term survival was 68 +/- 4%, freedom from thromboembolism 80 +/- 4%, and freedom from valve dysfunction 87 +/- 4%. In the replacement group for mitral regurgitation operative mortality was 11%, 20% with coronary artery bypass. Operative survival was 53 +/- 5% at 9 years, freedom from thromboembolism was 87 +/- 3%, and freedom from valve dysfunction was 91 +/- 4%.
随着各种人工心脏瓣膜和生物人工心脏瓣膜在生存、血栓栓塞现象以及再次手术发生率方面的晚期结果现已可得，针对病变二尖瓣的重建手术与置换手术之间的争论具有了新的重要意义。本文介绍了布莱根妇女医院1972年至1984年的三组患者，其中120例患者因二尖瓣狭窄接受二尖瓣开放重建手术，348例患者因二尖瓣狭窄接受二尖瓣置换手术，363例患者因二尖瓣反流接受二尖瓣置换手术。重建组的手术死亡率为0，有5例晚期死亡，均为非心脏原因，9例患者发生血栓栓塞（1.8%/患者年），9例患者需要再次手术（1.7%/患者年）。对于因二尖瓣狭窄接受二尖瓣置换的患者，手术死亡率为10%，单纯置换为6%，若包括冠状动脉搭桥则为20%。9年时长期生存率为68±4%，无血栓栓塞率为80±4%，无瓣膜功能障碍率为87±4%。在二尖瓣反流置换组中，手术死亡率为11%，冠状动脉搭桥时为20%。9年时手术生存率为53±5%，无血栓栓塞率为87±3%，无瓣膜功能障碍率为91±4%。
