Laschinger J C, Cunningham J N, Baumann F G, Isom O W, Catinella F P, Mendelsohn A, Adams P X, Spencer F C
Ann Thorac Surg. 1982 Sep;34(3):287-98. doi: 10.1016/s0003-4975(10)62498-8.
Between 1967 and 1979, 411 patients underwent surgical treatment of isolated mitral stenosis at our institution. Open radical mitral commissurotomy was performed in 150 patients (1967-1978; mean follow-up, 46 months; range, 4 to 116 months). Mitral valve replacement using a porcine prosthesis was performed in 74 patients (1976-1979; mean follow-up, 23 months; range, 2 to 48 months). Mitral valve replacement with a cloth-covered Starr-Edwards prosthesis was performed in 187 patients (1967-1975; mean follow-up, 45 months; range, 2 to 106 months). Preoperative characteristics were similar in the three groups. The open commissurotomy and Starr-Edwards groups were followed up to 9 years and the porcine valve group up to 4 years, with 97% follow-up in each group. Life-table analysis (6-month intervals) of all postoperative complications revealed significantly greater complication-free survival for patients who had open radical commissurotomy compared with Starr-Edwards (p less than 0.05) valve replacement. Similar analysis of thromboembolic and warfarin-related complications revealed significantly fewer complications in commissurotomy patients. No significant differences were found (p greater than 0.05) when comparing the need for subsequent reoperation in each group. Operative mortality following open radical mitral commissurotomy (0%; 0 out of 150) was significantly less (p less than 0.05) than after mitral valve replacement in both porcine (8.1%; 6 out of 74) and Starr-Edwards (11.2%; 21 out out 187) groups. Life-table analysis of late cardiac-related mortality revealed a significantly greater cumulative survival rate for the commissurotomy versus the Starr-Edwards groups at all intervals from 12 to 108 months (100 versus 84 +/- 5%, p less than 0.05). No significant differences were noted between commissurotomy and porcine valve groups during the 4-year follow-up period (100 +/- 0% versus 96 +/- 3%, p greater than 0.05). Based on these findings, we conclude that when the anatomy is favorable, the surgical treatment of choice for isolated mitral stenosis is open radical mitral commissurotomy.
1967年至1979年间，我院对411例单纯二尖瓣狭窄患者进行了手术治疗。150例患者（1967 - 1978年；平均随访46个月，范围4至116个月）接受了直视下二尖瓣根治性交界切开术。74例患者（1976 - 1979年；平均随访23个月，范围2至48个月）使用猪瓣膜进行了二尖瓣置换术。187例患者（1967 - 1975年；平均随访45个月，范围2至106个月）使用带布覆盖的Starr - Edwards瓣膜进行了二尖瓣置换术。三组患者的术前特征相似。直视下交界切开术组和Starr - Edwards瓣膜组随访9年，猪瓣膜组随访4年，每组随访率均为97%。对所有术后并发症进行的生存分析（间隔6个月）显示，与Starr - Edwards瓣膜置换术相比，接受直视下二尖瓣根治性交界切开术的患者无并发症生存时间显著更长（p小于0.05）。对血栓栓塞和华法林相关并发症的类似分析显示，交界切开术患者的并发症明显更少。比较每组后续再次手术的需求时未发现显著差异（p大于0.05）。直视下二尖瓣根治性交界切开术的手术死亡率为0%（150例中0例），显著低于猪瓣膜组（8.1%；74例中6例）和Starr - Edwards瓣膜组（11.2%；187例中21例）二尖瓣置换术后的手术死亡率（p小于0.05）。对晚期心脏相关死亡率的生存分析显示，在12至108个月的所有时间段内，交界切开术组的累积生存率显著高于Starr - Edwards瓣膜组（分别为100%和84%±5%，p小于0.05）。在4年随访期内，交界切开术组和猪瓣膜组之间未发现显著差异（分别为100%±0%和96%±3%，p大于0.05）。基于这些发现，我们得出结论，当解剖结构适宜时，单纯二尖瓣狭窄的手术治疗首选直视下二尖瓣根治性交界切开术。
