Maisano F, Torracca L, Oppizzi M, Stefano P L, D'Addario G, La Canna G, Zogno M, Alfieri O
Division of Cardiac Surgery, IRCCS S. Raffaele Hospital, Milano, Italy.
Eur J Cardiothorac Surg. 1998 Mar;13(3):240-5; discussion 245-6. doi: 10.1016/s1010-7940(98)00014-1.
Repair of mitral regurgitation (MR) is more demanding in case of prolapse of the anterior leaflet, posterior leaflet with calcified annulus, or prolapse of both leaflets. We evaluated a repair which consists of anchoring the free edge of the prolapsing leaflet to the corresponding free edge of the facing leaflet: the 'edge-to-edge' (E-to-E) technique. The correction results in a double orifice valve when the prolapse is in the middle portion of the leaflet and in a smaller valve orifice when the prolapse is close to a commissure.
Out of 432 patients with MR submitted to valve repair between January 1991 and September 1997, 121 (mean age 56 +/- 15.8 years) underwent E-to-E correction. The most prevalent etiology was degenerative disease (82 patients, 68%). The mechanism of MR was anterior leaflet prolapse (61 patients), posterior leaflet prolapse (24 patients), prolapse of both leaflets (28 patients) and other complex mechanisms (8 patients). In 72 patients, a double orifice was created, the paracommissural repair was done in 49 patients.
Hospital mortality was 1.6%. Overall survival was 92 +/- 3.1% at 6 years with 95 +/- 4.8% freedom from reoperation. Mortality was unrelated to the type of repair. Mitral stenosis was never observed after the correction. At the follow-up (mean 2.2 +/- 1.5 years), all patients but 15 are class I or II. Symptoms at the follow-up are not related to residual MR.
Midterm results of this alternative repair technique are promising, considering the high prevalence of complex anatomical lesions. The technique is simple, easily reproducible and rapidly feasible also when mitral exposure is suboptimal.
对于前叶脱垂、后叶脱垂合并瓣环钙化或双叶脱垂的二尖瓣反流（MR）患者，二尖瓣修复术的难度更大。我们评估了一种修复方法，即将脱垂瓣叶的游离缘固定于相对瓣叶的相应游离缘：“边对边”（E-to-E）技术。当脱垂位于瓣叶中部时，矫正结果会形成双孔瓣膜；当脱垂靠近瓣叶交界时，瓣膜口会变小。
在1991年1月至1997年9月期间接受瓣膜修复的432例MR患者中，121例（平均年龄56±15.8岁）接受了E-to-E矫正。最常见的病因是退行性疾病（82例，68%）。MR的机制为前叶脱垂（61例）、后叶脱垂（24例）、双叶脱垂（28例）以及其他复杂机制（8例）。72例患者形成了双孔，49例患者进行了瓣叶交界旁修复。
医院死亡率为1.6%。6年时总体生存率为92±3.1%，再次手术的自由度为95±4.8%。死亡率与修复类型无关。矫正后从未观察到二尖瓣狭窄。随访（平均2.2±1.5年）时，除15例患者外，所有患者的心功能分级均为I级或II级。随访时的症状与残余MR无关。
考虑到复杂解剖病变的高发生率，这种替代性修复技术的中期结果很有前景。该技术简单，易于重复，即使二尖瓣暴露欠佳时也能迅速实施。
