Balloon mitral commissurotomy after previous surgical commissurotomy. The National Heart, Lung, and Blood Institute Balloon Valvuloplasty Registry participants.
Balloon mitral commissurotomy after previous surgical commissurotomy. The National Heart, Lung, and Blood Institute Balloon Valvuloplasty Registry participants.
复制标题
先前手术连合切开术后进行球囊二尖瓣连合切开术。
DOI：
10.1161/01.cir.86.1.91
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发表时间：
1992
期刊：
影响因子：
37.8
通讯作者：
Davis,K
中科院分区：
文献类型：
--
作者：
Davidson,CJ;Bashore,TM;Mickel,M;Davis,K
手术二尖瓣分离术后的二尖瓣再狭窄通常发生在5-15年内，需要重复手术。球囊二尖瓣分离术（BMC）已被提倡作为二尖瓣再狭窄的重复手术的替代方法。方法和结论本研究的目的是确定在先前的外科分离术后接受BMC的患者的短期和中期结果，将这些患者与接受球囊二尖瓣分离术作为初始程序的患者进行比较，并阐明急性手术和临床结果的多变量决定因素。作为国家心脏、肺和血液研究所球囊瓣膜成形术登记研究的一部分，738例接受BMC的患者中，133例在既往外科二尖瓣分离术后接受BMC。获得的前瞻性数据包括人口统计学、血流动力学、超声心动图和临床随访。既往外科连合切开术后的BMC使跨瓣压差从13 +/- 5显著降低至6 +/- 3 mm Hg（p <0.0001），二尖瓣面积从1.0 +/- 0.3增加至1.8 +/- 0.8 cm 2（p <0.0001）。BMC作为初始手术将瓣膜面积从1.0 +/- 0.4增加至2.0 +/- 0.8 cm 2（p <0.0001）（与既往手术相比，p = 0.03）。两组的基线特征（包括二尖瓣超声评分）相似。比较既往手术患者与未手术患者的6个月状态，80%与90%的患者为纽约心脏协会（NYHA）心功能I级或II级（p = 0.004）。死亡率相似。在既往接受过二尖瓣手术的患者中，6个月临床状态改善的多变量预测因素包括中心经验（p = 0.006）、较低的超声心动图评分（p = 0.001）和较低的左心室舒张末期压（p = 0.008）。最终二尖瓣面积大于或等于1.5 cm 2的多变量决定因素是较低的基线NYHA功能分级（p = 0.003）和较低的二尖瓣超声心动图评分（p = 0.008）。6个月时症状改善在既往连合切开术患者中的发生率略低。在经验丰富的中心接受BMC的瓣膜形态良好且左心室功能保留的患者最有可能在既往外科连合切开术后获得症状改善。一般而言，BMC是既往外科二尖瓣分离术后二尖瓣再狭窄的有效治疗方法。
BACKGROUNDMitral restenosis after surgical mitral commissurotomy often occurs within 5-15 years, necessitating a repeat procedure. Balloon mitral commissurotomy (BMC) has been advocated as an alternative to repeat surgery for mitral restenosis.METHODS AND RESULTSThe purposes of this study are to determine the short- and intermediate-term outcomes of patients undergoing BMC after previous surgical commissurotomy, to compare these patients with those undergoing balloon mitral commissurotomy as an initial procedure, and to elucidate the multivariate determinants of acute procedural and clinical outcome. Of 738 patients undergoing BMC as part of the National Heart, Lung, and Blood Institute Balloon Valvuloplasty Registry, 133 underwent BMC after previous surgical mitral commissurotomy. Prospective data obtained included demographic, hemodynamic, echocardiographic, and clinical follow-up. BMC after previous surgical commissurotomy produced a significant reduction in transvalvular gradient from 13 +/- 5 to 6 +/- 3 mm Hg (p less than 0.0001) and an increase in mitral valve area from 1.0 +/- 0.3 to 1.8 +/- 0.8 cm2 (p less than 0.0001). BMC as an initial procedure increased valve area from 1.0 +/- 0.4 to 2.0 +/- 0.8 cm2 (p less than 0.0001) (p = 0.03 versus prior surgery). Baseline characteristics including mitral valve echo score were similar for both groups. Comparing 6-month status in patients with prior surgery to those without, 80% versus 90% were New York Heart Association (NYHA) functional class I or II (p = 0.004). Mortality was similar. In patients with previous mitral valve surgery, multivariate predictors of improvement in 6-month clinical status included the experience of the center (p = 0.006), lower echocardiographic score (p = 0.001), and lower left ventricular end-diastolic pressure (p = 0.008). Multivariate determinants of a final mitral valve area greater than or equal to 1.5 cm2 were a lower baseline NYHA functional class (p = 0.003) and lower mitral valve echocardiographic score (p = 0.008).CONCLUSIONSBMC after previous surgical mitral commissurotomy results in similar hemodynamic changes as in patients undergoing BMC as an initial procedure. Symptomatic improvement at 6 months is slightly less frequent in prior commissurotomy patients. Patients with favorable valvular morphology and preserved left ventricular function who undergo BMC in experienced centers are most likely to achieve symptomatic improvement after previous surgical commissurotomy. In general, BMC is an effective treatment for mitral restenosis after previous surgical commissurotomy.