Durability of mitral valve repair in Barlow disease versus fibroelastic deficiency
Durability of mitral valve repair in Barlow disease versus fibroelastic deficiency
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DOI：
10.1016/j.jtcvs.2007.06.040
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发表时间：
2008-02-01
影响因子：
6
通讯作者：
Herregods, Marie-Christine
中科院分区：
文献类型：
--
作者：
Flameng, Willem;Meuris, Bart;Herregods, Marie-Christine
目的：退行性瓣膜关闭不全二尖瓣修复术的耐久性评估仅限于以再次手术作为主要指标，以瓣膜相关的晚期死亡危险因素作为次要指标。我们评估了瓣膜功能的连续超声心动图随访，作为二尖瓣修复耐久性的指标。方法和结果：在 348 名因退行性瓣膜功能不全而接受二尖瓣修复的患者中，临床结果非常出色：修复后 10 年，生存率为 80.1%，无需再次手术的率为 94.4%。然而，无二尖瓣反流 (> 2/4)，1 个月时为 98.7%，5 年时降至 82.2%，10 年时降至 64.9%。二尖瓣反流的线性复发率为每年 3.2%（> 2/4）。巴洛病患者的复发率较高 (6.0%)，纤维弹性缺陷患者的复发率较低 (2.6%) (P = .01)。进行腱索缩短术、不使用滑动成形术和不使用瓣环成形术环被确定为预测二尖瓣反流复发的因素。在避免这些危险因素的重建中，复发率降至 2.4%。巴洛病和纤维弹性缺陷之间没有差异：2.9% 与 2.2% (P > .05)。复发性关闭不全的特点是瓣叶脱垂、增厚和钙化。结论：当采用最佳手术技术时，二尖瓣关闭不全的残余复发率每年保持在2%至3%之间，并且与腱索和瓣叶的进行性退变有关。巴洛病二尖瓣修复的长期结果与纤维弹性缺陷症基本相同。
Objective: Durability assessment of mitral valve repair for degenerative valve incompetence is limited to reoperation as a primary indicator and valve- related risk factors for late death as a secondary indicator. We assessed serial echocardiographic follow-up of valve function as an indicator of the durability of mitral valve repair.Methods and Results: In 348 patients having undergone mitral valve repair for degenerative valve incompetence, clinical outcome was excellent: 10 years after repair, survival was 80.1% and freedom from reoperation 94.4%. However, freedom from mitral regurgitation (> 2/4), 98.7% at 1 month, decreased to 82.2% at 5 years and 64.9% at 10 years. The linearized recurrence rate of mitral regurgitation (> 2/4) was 3.2% per year. Recurrence rate was higher in patients with Barlow disease (6.0%) and lower in those with fibroelastic deficiency (2.6%) (P = .01). Performing chordal shortening, the nonuse of sliding plasty and the nonuse of an annuloplasty ring were determined to be factors predicting recurrence of mitral regurgitation. In reconstructions avoiding these risk factors, recurrence rate decreased to 2.4%. There was no difference between Barlow disease and fibroelastic deficiency: 2.9% versus 2.2% (P > .05). Recurrent regurgitation is characterized by leaflet prolapse, thickening, and calcification.Conclusion: When optimal surgical techniques are used, the residual recurrence rate of mitral valve regurgitation remains between 2% and 3% per year and is related to progressive degeneration of the chordae and the leaflets. Long- term results of mitral valve repair in Barlow disease are essentially the same as in fibroelastic deficiency.