Eishi K, Kawazoe K, Sasako Y, Kosakai Y, Kitoh Y, Kawashima Y
Division of Cardiovascular Surgery, National Cardiovascular Center of Japan, Osaka.
J Heart Valve Dis. 1994 Jul;3(4):432-8.
Between January 1978 and September 1992, 127 patients with isolated mitral regurgitation due to prolapse underwent mitral valve reconstruction. There were 74 men and 53 women whose mean age was 49.7 years, ranging from 16 to 74 years. Follow up was 99.2% complete and totaled 483.0 patient-years (mean: 3.8 years). One hundred and forty-eight procedures were carried out to repair the prolapses using four types of techniques: (1) leaflet plication in 97 patients; (2) artificial chordal replacement with polytetrafluoroethylene sutures in 30 patients; (3) chordal shortening in 16 patients; and (4) commissural imbrication in five patients. In order to repair the annular dilation, commissural plications were done in 75 and ring prostheses were implanted in 15 patients. There were one hospital and eight late deaths. One (cerebral infarction) of all deaths was related to the reconstructed mitral valve. There were 14 reoperations (11.0%) for recurrent mitral incompetence with a freedom from reoperation of 89.0% at five, and 81.1% at 10 years. There were four cases of thromboembolism (one fatal, three non-fatal) with freedom from thromboembolism of 96.7% at five, and 93.3% at 10 years. No endocarditis or hemorrhagic complications were noted. Linearized incidence of recurrent mitral regurgitation according to repair technique for the prolapse was 1.44%/pty in the leaflet plication series, 1.45%/pty with chordal replacement, 4.37%/pty after chordal shortening and 8.67%/pty following commissural imbrication. The linearized rate of failure in annuloplasty was 2.91%/pty after commissural plication and 1.74%/pty after ring annuloplasty. Statistically significant difference was confirmed only between leaflet plication and chordal shortening.(ABSTRACT TRUNCATED AT 250 WORDS)
1978年1月至1992年9月期间，127例因二尖瓣脱垂导致单纯二尖瓣反流的患者接受了二尖瓣重建手术。其中男性74例，女性53例，平均年龄49.7岁，年龄范围为16至74岁。随访完成率为99.2%，总计483.0患者年（平均：3.8年）。采用四种技术进行了148例修复脱垂的手术：（1）97例患者行瓣叶折叠术；（2）30例患者用聚四氟乙烯缝线进行人工腱索置换；（3）16例患者行腱索缩短术；（4）5例患者行交界折叠术。为修复瓣环扩张，75例患者行交界折叠术，15例患者植入人工瓣环。有1例院内死亡和8例晚期死亡。所有死亡病例中有1例（脑梗死）与重建的二尖瓣有关。因二尖瓣反流复发进行了14例再次手术（11.0%），5年时再次手术的自由度为89.0%，10年时为81.1%。有4例血栓栓塞病例（1例致命，3例非致命），5年时无血栓栓塞的自由度为96.7%，10年时为93.3%。未发现心内膜炎或出血并发症。根据脱垂修复技术，瓣叶折叠术系列中二尖瓣反流复发的线性发生率为1.44%/患者年，腱索置换为1.45%/患者年，腱索缩短术后为4.37%/患者年，交界折叠术后为8.67%/患者年。交界折叠术后瓣环成形术失败的线性发生率为2.91%/患者年，人工瓣环瓣环成形术后为1.74%/患者年。仅在瓣叶折叠术和腱索缩短术之间证实有统计学显著差异。（摘要截断于250字）
