David T E, Omran A, Armstrong S, Sun Z, Ivanov J
Division of Cardiovascular Surgery, The Toronto Hospital and the University of Toronto, Ontario, Canada.
J Thorac Cardiovasc Surg. 1998 Jun;115(6):1279-85; discussion 1285-6. doi: 10.1016/S0022-5223(98)70210-7.
This study was carried out to evaluate the long-term results of mitral valve repair for mitral regurgitation caused by myxomatous disease of the mitral valve and the late effects of chordal replacement with expanded polytetrafluoroethylene sutures in this operation.
A total of 324 patients with mitral regurgitation caused by myxomatous disease underwent mitral valve repair from 1981 to 1995; the group comprised 241 men and 83 women whose mean age was 58 +/- 14 years. Chordal replacement with expanded polytetrafluoroethylene sutures has been performed in 165 patients since 1985. Most of the patients who had chordal replacement with expanded polytetrafluoroethylene sutures had prolapse of the anterior leaflet or prolapse of both leaflets, whereas most patients who had mitral valve repair without chordal replacement had prolapse of the posterior leaflet. Patients were followed up at annual intervals and had a Doppler echocardiographic study. The follow-up was complete and extended from 6 to 156 months (mean 36 +/- 30 months).
Two operative and 21 late deaths occurred (14 cardiac and 7 noncardiac). At 10 years the actuarial survival was 75% +/- 5%, the freedom from stroke was 94% +/- 2%, the freedom from transient ischemic attacks was 92% +/- 4%, the freedom from endocarditis was 99% +/- 1%, the freedom from mitral valve reoperation was 96% +/- 1%, and the freedom from severe mitral regurgitation was 93% +/- 3%. Chordal replacement with expanded polytetrafluoroethylene sutures had no effect on any of these end points.
Mitral valve repair was feasible in most patients with mitral regurgitation caused by myxomatous disease and it was associated with low rates of valve-related complications. Chordal replacement with expanded polytetrafluoroethylene had no adverse effect on the late outcome and was believed to have increased the probability of mitral valve repair.
本研究旨在评估二尖瓣黏液瘤病所致二尖瓣反流行二尖瓣修复术的长期效果，以及该手术中使用膨体聚四氟乙烯缝线进行腱索置换的远期影响。
1981年至1995年期间，共有324例二尖瓣黏液瘤病所致二尖瓣反流患者接受了二尖瓣修复术；该组包括241例男性和83例女性，平均年龄为58±14岁。自1985年以来，165例患者采用膨体聚四氟乙烯缝线进行了腱索置换。大多数采用膨体聚四氟乙烯缝线进行腱索置换的患者存在前叶脱垂或双叶脱垂，而大多数未进行腱索置换的二尖瓣修复患者存在后叶脱垂。患者每年接受随访，并进行多普勒超声心动图检查。随访完整，时间从6个月至156个月（平均36±30个月）。
发生2例手术死亡和21例晚期死亡（14例心脏相关死亡和7例非心脏相关死亡）。10年时，精算生存率为75%±5%，无卒中生存率为94%±2%，无短暂性脑缺血发作生存率为92%±4%，无感染性心内膜炎生存率为99%±1%，无需再次进行二尖瓣手术生存率为96%±1%，无严重二尖瓣反流生存率为93%±3%。采用膨体聚四氟乙烯缝线进行腱索置换对这些终点指标均无影响。
对于大多数二尖瓣黏液瘤病所致二尖瓣反流患者，二尖瓣修复术是可行的，且与较低的瓣膜相关并发症发生率相关。采用膨体聚四氟乙烯进行腱索置换对远期结局无不良影响，且被认为增加了二尖瓣修复的可能性。
