el Issa A
Service de Chirurgie Cardio-thoracique et Vasculaire, Centre Hospitaller Départemental Félix Guyon, Saint-Denis (La Réunion).
Ann Cardiol Angeiol (Paris). 1996 Jul-Sep;45(7):377-82.
Mitral valve surgery represents 34.6% of all open heart surgery in our unit. The aim of this study is to assess the early and intermediate term results in a consecutive series of 81 mitral valve replacements (mechanical: 67, bioprosthesis: 14) performed between September 1991 and December 1993. The mean age was 45.7 +/- 15 years (male 26, female 55). Twenty five patients (30.9%) were classified as functional class II of the New York Heart Association classification (NYHA) and 56 (89.1%) as class III or IV. Eight were operated in an emergency. Acute rheumatic fever (49.3%) and bioprosthetic dysfunction were the two main etiologies. Thirty patients (37%) had a history of previous cardiac surgery. Hospital mortality was 13.8% (11 patients). Risk factors associated with high operative mortality were: age, emergency, previous cardiac surgery, atrial fibrillation and tricuspid annuloplasty. All survivors were contacted. Mean follow-up was 30.8 +/- 9 months (range: 3.1-46.4). Five patients had died by the last date of follow-up. Actuarial survival at 1 and 4 years was 86% and 77%, respectively. Late events were mainly 9 episodes of thrombosis, 3 cases of thrombo-embolism and 1 peri-prosthetic leak; five patients were reoperated. The linearized incidence of these events was respectively: 5.1%, 1.7%, 0.5% and 3.4% per patient/year, respectively. There were no complications in case of bioprostheses. Functional improvement was satisfactory and 93% of patients were in NYHA class I or II at the most recent follow-up. Functional results after mitral valve replacement were satisfactory, regardless the type of prosthesis; however valve-related complications are very serious. Conservative mitral surgery is currently our first choice whenever possible.
二尖瓣手术占我们科室所有心脏直视手术的34.6%。本研究的目的是评估1991年9月至1993年12月期间连续进行的81例二尖瓣置换术（机械瓣：67例，生物瓣：14例）的早期和中期结果。平均年龄为45.7±15岁（男性26例，女性55例）。25例患者（30.9%）被归类为纽约心脏协会（NYHA）心功能II级，56例（89.1%）为III级或IV级。8例为急诊手术。急性风湿热（49.3%）和生物瓣功能障碍是两个主要病因。30例患者（37%）有心脏手术史。住院死亡率为13.8%（11例患者）。与高手术死亡率相关的危险因素有：年龄、急诊手术、既往心脏手术史、心房颤动和三尖瓣环成形术。对所有幸存者进行了随访。平均随访时间为30.8±9个月（范围：3.1 - 46.4个月）。到最后随访日期时，有5例患者死亡。1年和4年的精算生存率分别为86%和77%。晚期事件主要有9次血栓形成、3例血栓栓塞和1例人工瓣周漏；5例患者再次手术。这些事件的线性发生率分别为：每位患者每年5.1%、1.7%、0.5%和3.4%。生物瓣未出现并发症。功能改善情况令人满意，在最近一次随访时，93%的患者处于NYHA I级或II级。无论使用何种类型的人工瓣膜，二尖瓣置换术后的功能结果都令人满意；然而，与瓣膜相关的并发症非常严重。只要有可能，目前我们首选保守性二尖瓣手术。
