INITIAL EXPERIENCE WITH THE COSGROVE-EDWARDS ANNULOPLASTY SYSTEM
INITIAL EXPERIENCE WITH THE COSGROVE-EDWARDS ANNULOPLASTY SYSTEM
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DOI：
10.1016/0003-4975(95)00458-w
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发表时间：
1995-09-01
影响因子：
4.6
通讯作者：
THOMAS, JD
中科院分区：
文献类型：
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作者：
COSGROVE, DM;ARCIDI, JM;THOMAS, JD
背景资料。二尖瓣具有非平面形状和括约肌作用。病理性扩张沿后环发生。为了保留生理功能和纠正环状扩张症，我们开发了一种具有普遍灵活性的环状成形术系统(Cosgrove-Edwards环状成形术系统)。对连续150例二尖瓣成形术的结果进行了分析。平均年龄为58岁+/-13岁；59%为男性。瓣膜疾病的原因是退行性的占75%，风湿性的占13%，缺血性的占8%，感染性的占4%。61例(41%)患者接受了相关手术。超声心动图二尖瓣返流由术前的3.7±-0.6降至术后的0.2+/-0.4(p<；0.0001)。没有住院死亡，也没有血液动力学明显的收缩前移或其他环状成形术相关的并发症。术后100%完成随访，平均3.1+/-3.6个月。有3例晚期死亡，3例短暂性脑缺血发作，1例心内膜炎发作。5名患者(3.3%)因二尖瓣关闭不全复发而再次手术；没有与二尖瓣成形术系统有关的再次手术。在平均9个月时，从多个超声心动图图像对二尖瓣环进行三维重建，证实了二尖瓣环的非平面形状和括约肌机制。环口面积在心动周期内减少了19%，从舒张期的平均值10.3 cm(2)减少到收缩期的8.6 cm(2)。该瓣环成形术可有效修复继发于各种原因的瓣膜功能不全，保留生理性瓣环功能，且瓣膜相关并发症发生率低。
Background. The mitral valve has a nonplanar shape and a sphincter action. Pathologic dilatation occurs along the posterior annulus. To preserve the physiologic function and correct annular dilatation, we developed an annuloplasty system that is universally flexible and produces a measured plication of the posterior annulus (Cosgrove-Edwards Annuloplasty System).Methods. The results of 150 consecutive mitral valve repairs using this system were analyzed. Mean age was 58 +/- 13 years; 59% were men. The cause of the valve disease was degenerative in 75% of the patients, rheumatic in 13%, ischemic in 8%, and infectious in 4%. Associated procedures were performed in 61 patients (41%).Results. Echocardiographic mitral regurgitation decreased from 3.7 +/- 0.6 before repair to 0.2 +/- 0.4 after repair (p < 0.0001). There were no hospital deaths and no cases of hemodynamically significant systolic anterior motion or other annuloplasty-related complications. Follow-up was 100% complete at a mean of 3.1 +/- 3.6 months. There were three late deaths, three transient ischemic attacks, and one episode of endocarditis. Five patients (3.3%) have undergone reoperation for recurrent mitral insufficiency; no reoperations were related to the annuloplasty system. At a mean of 9 months, three-dimensional reconstruction of the mitral annulus from multiple echocardiographic images confirmed the nonplanar shape and sphincter mechanism of the annulus. Annular orifice area decreased 19% during the cardiac cycle from a mean of 10.3 cm(2) in diastole to 8.6 cm(2) in systole.Conclusions. This annuloplasty system is effective for repair of insufficiency secondary to all causes, preserves physiologic annulus function, and is associated with a low incidence of valve-related complication.