Bolling S F, Pagani F D, Deeb G M, Bach D S
Section of Thoracic Surgery, The University of Michigan, Ann Arbor 48109, USA.
J Thorac Cardiovasc Surg. 1998 Feb;115(2):381-6; discussion 387-8. doi: 10.1016/S0022-5223(98)70282-X.
Severe mitral regurgitation is a frequent complication of end-stage cardiomyopathy that contributes to heart failure and predicts a poor survival. We studied the intermediate-term outcome of mitral reconstruction in 48 patients who had cardiomyopathy with severe mitral regurgitation and were operated on between June 1993 and June 1997.
Ages ranged from 33 to 79 years (63 +/- 6 years) with left ventricular ejection fractions of 8% to 25% (16% +/- 3%). All patients were receiving maximal drug therapy and were in New York Heart Association class III-IV with severe, refractory 4+ mitral regurgitation. Operatively, all 48 had undersized flexible annuloplasty rings inserted, 7 had coronary bypass grafts for incidental disease, 11 had prior bypass grafts, and 11 also had tricuspid valve repair.
One operative death occurred as a result of right ventricular failure. Postoperative transesophageal echocardiography revealed mild mitral regurgitation in 7 patients and no mitral regurgitation in 41. There were 10 late deaths, 2 to 47 months after mitral reconstruction. The 1- and 2-year actuarial survivals have been 82% and 71%. At a mean follow-up of 22 months, the number of hospitalizations for heart failure has decreased, and 1 patient has had heart transplantation. Significantly, New York Heart Association class improved from 3.9 +/- 0.3 before the operation to 2.0 +/- 0.6 after the operation. Twenty-four months after the operation, left ventricular volume and sphericity have decreased, whereas ejection fraction and cardiac output have increased.
Whether this favorable modification of left ventricular function and geometry will persist remains unknown. However, mitral repair for cardiomyopathy with mitral regurgitation allows new strategies for these patients.
重度二尖瓣反流是终末期心肌病的常见并发症，可导致心力衰竭并预示生存率较低。我们研究了1993年6月至1997年6月间接受手术治疗的48例患有心肌病并伴有重度二尖瓣反流患者二尖瓣重建的中期结果。
患者年龄在33至79岁之间（平均63±6岁），左心室射血分数为8%至25%（平均16%±3%）。所有患者均接受最大程度的药物治疗，纽约心脏协会心功能分级为III-IV级，伴有重度、难治性4+级二尖瓣反流。手术中，48例患者均植入了尺寸偏小的弹性瓣环成形环，7例因合并其他疾病进行了冠状动脉搭桥术，11例曾接受过冠状动脉搭桥术，11例还进行了三尖瓣修复术。
1例患者因右心室衰竭发生手术死亡。术后经食管超声心动图显示，7例患者存在轻度二尖瓣反流，41例无二尖瓣反流。二尖瓣重建术后2至47个月有10例晚期死亡。1年和2年的预期生存率分别为82%和71%。平均随访22个月时，因心力衰竭住院的次数减少，1例患者接受了心脏移植。值得注意的是，纽约心脏协会心功能分级从术前的3.9±0.3改善至术后的2.0±0.6。术后24个月，左心室容积和球形度减小，而射血分数和心输出量增加。
左心室功能和形态的这种有利改变是否会持续尚不清楚。然而，对患有二尖瓣反流的心肌病患者进行二尖瓣修复为这些患者提供了新的治疗策略。
