Chen F Y, Adams D H, Aranki S F, Collins J J, Couper G S, Rizzo R J, Cohn L H
Division of Cardiac Surgery, Brigham and Women's Hospital, Boston, MA 02115, USA.
Circulation. 1998 Nov 10;98(19 Suppl):II124-7.
Volume overload secondary to mitral regurgitation (MR) in cardiomyopathy is considered critical in the pathogenesis of subsequent ventricular dysfunction. Open mitral valve repair (OMVP) is hypothesized to improve symptomatology and ventricular function by reducing the volume overload of the left ventricle.
All patients who underwent OMVP with a left ventricular ejection fraction (EF) of < 0.30 (n = 81) from 1984 through 1997 were reviewed (1 patient was lost to follow-up). Fifteen operations (18.5%) were repeat operations after previous coronary artery bypass graft surgery. Preoperative and postoperative EFs and NYHA class were compared. Survival probabilities were calculated, and multivariate analysis was performed. The average age of all patients was 67.1 years (range, 41 to 83 years). Mean follow-up was 1.7 years (range, 2 months to 8.5 years). The most common mitral repair was ring annuloplasty. Sixty-two patients (77%) had concomitant coronary artery bypass graft surgery. The surgery mortality rate was 11% (9 of 81); 6 of these 9 patients were > 70 years old. The overall Kaplan-Meier survival probability rate at 1, 2, 3, 4, and 5 years was 0.73, 0.68, 0.58, 0.50, and 0.38, respectively. EF improved significantly (0.24 to 0.32; P < 0.0001), as did the NYHA class (3.2 to 1.6; P < 0.0001), at follow-up. There was no difference in late survival between patients with an EF of < 0.20 (21 patients) and those with an EF between 0.20 and 0.30 (P = NS). Risk factors for death included heart failure and old age.
OMVP for MR in the setting of ischemic cardiomyopathy and low EF appear to improve ventricular function, medium-term patient symptomatology, and survival.
心肌病中二尖瓣反流（MR）继发的容量超负荷被认为在随后心室功能障碍的发病机制中至关重要。开放式二尖瓣修复术（OMVP）被认为可通过减轻左心室的容量超负荷来改善症状和心室功能。
回顾了1984年至1997年间所有接受OMVP且左心室射血分数（EF）<0.30的患者（n = 81）（1例患者失访）。15例手术（18.5%）是在先前冠状动脉搭桥手术后的再次手术。比较术前和术后的EF及纽约心脏协会（NYHA）分级。计算生存概率，并进行多因素分析。所有患者的平均年龄为67.1岁（范围41至83岁）。平均随访时间为1.7年（范围2个月至8.5年）。最常见的二尖瓣修复术是环缩成形术。62例患者（77%）同时进行了冠状动脉搭桥手术。手术死亡率为11%（81例中的9例）；这9例患者中有6例年龄>70岁。1、2、3、4和5年时的总体Kaplan-Meier生存概率分别为0.73、0.68、0.58、0.50和0.38。随访时EF显著改善（从0.24至0.32；P<0.0001），NYHA分级也显著改善（从3.2至1.6；P<0.0001）。EF<0.20的患者（21例）与EF在0.20至0.30之间的患者的晚期生存率无差异（P=无显著性差异）。死亡的危险因素包括心力衰竭和高龄。
在缺血性心肌病和低EF情况下进行的OMVP似乎可改善心室功能、中期患者症状及生存率。
