二尖瓣狭窄球囊瓣膜成形术与手术治疗的比较。

Comparison of balloon valvuloplasty with operative treatment for mitral stenosis.

作者信息

Cohen J M, Glower D D, Harrison J K, Bashore T M, White W D, Smith L R, Rankin J S, Sabiston D C

机构信息

Department of Surgery, Duke University Medical Center, Durham, North Carolina 27710.

出版信息

Ann Thorac Surg. 1993 Dec;56(6):1254-62. doi: 10.1016/0003-4975(93)90662-2.

DOI:10.1016/0003-4975(93)90662-2

PMID:8267421

Abstract

To determine the optimal role for percutaneous balloon mitral valvuloplasty or open mitral commissurotomy, the outcome of 164 consecutive patients undergoing either percutaneous balloon mitral valvuloplasty, open mitral commissurotomy, or mitral valve replacement for mitral stenosis was reviewed. No preoperative differences existed between percutaneous balloon mitral valvuloplasty and open mitral commissurotomy in age, symptoms, or mitral valve characteristics. Symptoms improved similarly in all groups, and median hospital stays after procedures were 2, 9, and 10 days for percutaneous balloon mitral valvuloplasty, open mitral commissurotomy, and mitral valve replacement (p < 0.005). Actuarial survivals at 36 months did not differ significantly (83% +/- 6%, 94% +/- 4%, and 90% +/- 4%). Actuarial freedoms from subsequent mitral valve procedures at 36 months were 66% +/- 7%, 87% +/- 6%, and 100% +/- 13% (p < 0.005), with the linearized rate of subsequent mitral valve procedures being 12% +/- 3%, 4% +/- 2%, and 1.2% +/- 0.8%/patient-year for percutaneous balloon mitral valvuloplasty, open mitral commissurotomy, and mitral valve replacement (p < 0.01). Prior mitral commissurotomy increased the likelihood of subsequent mitral procedures after percutaneous balloon mitral valvuloplasty from 10% +/- 3% to 20% +/- 7%/patient-year.

摘要

为确定经皮球囊二尖瓣成形术或直视二尖瓣交界切开术的最佳作用，我们回顾了164例因二尖瓣狭窄接受经皮球囊二尖瓣成形术、直视二尖瓣交界切开术或二尖瓣置换术的连续患者的治疗结果。经皮球囊二尖瓣成形术和直视二尖瓣交界切开术在年龄、症状或二尖瓣特征方面术前无差异。所有组症状改善情况相似，经皮球囊二尖瓣成形术、直视二尖瓣交界切开术和二尖瓣置换术后的中位住院时间分别为2天、9天和10天（p<0.005）。36个月时的精算生存率无显著差异（分别为83%±6%、94%±4%和90%±4%）。36个月时免于后续二尖瓣手术的精算自由度分别为66%±7%、87%±6%和100%±13%（p<0.005），经皮球囊二尖瓣成形术、直视二尖瓣交界切开术和二尖瓣置换术后续二尖瓣手术的线性化发生率分别为12%±3%、4%±2%和1.2%±0.8%/患者年（p<0.01）。既往二尖瓣交界切开术使经皮球囊二尖瓣成形术后后续二尖瓣手术的可能性从10%±3%增加至20%±7%/患者年。