Mitral valve replacement for isolated mitral regurgitation: analysis of clinical course and late postoperative left ventricular ejection fraction.
Mitral valve replacement for isolated mitral regurgitation: analysis of clinical course and late postoperative left ventricular ejection fraction.
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二尖瓣置换术治疗孤立性二尖瓣反流：临床病程和术后晚期左心室射血分数分析。
DOI：
10.1016/0002-9149(81)90142-9
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发表时间：
1981
期刊：
影响因子：
--
通讯作者：
Pohost,GM
中科院分区：
文献类型：
--
作者：
Phillips,HR;Levine,FH;Carter,JE;Boucher,CA;Osbakken,MD;Okada,RD;Akins,CW;Daggett,WM;Buckley,MJ;Pohost,GM
1974年至1979年间，105例患者接受了二尖瓣置换术以缓解孤立性二尖瓣反流。住院死亡4例(4%)，晚期死亡12例，预测5年生存率为82%。手术时年龄大于或等于60岁以及术前左心室射血分数小于0.40是唯一与术后3-5年存活率下降相关的变量(p<；0.05)。术后87例(98%)存活于纽约心脏协会功能I级或II级(I级68例，II级19例)。猪瓣膜置换和机械瓣膜置换术患者的存活率没有差别，但机械瓣膜置换术患者术后脑血管意外发生率(8.6100年)高于猪瓣膜置换术患者(2.8100年)(p<；0.002)。对89例长期存活患者中的34例在术后12至75个月用多门控心脏成像测定静息状态下的射血分数。术前平均射血分数为0.001.6 2±0.0 9(平均标准差)，术后平均射血分数为0.5 0±0.15(p<；术前与术后静息值比较，射血分数增加0.10以上1例(3%)，维持在术前±0.09以内12例(35%)，降低0.10以上21例(62%)。术后射血分数大于0.50的17例患者中有16例(94%)术后功能I级，而术后射血分数小于或等于0.50的17例患者中有11例(65%)处于功能I级(p<；0.05)。术前因素，包括术前射血分数或心胸比率，均不能预测术后射血分数。29例患者术后获得运动射血分数，20例(69%)患者运动后射血分数异常变化(增加<；0.05)。研究时患者的年龄与从休息到运动的射血分数的变化呈负相关；没有其他变量是可预测的。结论是，除年龄外，只有通过射血分数测量的术前左心功能才能预测接受二尖瓣置换术的孤立性二尖瓣反流患者的存活率。尽管大多数长期存活者术后射血分数降低，但临床恢复良好。
One hundred five patients underwent mitral valve replacement for relief of isolated mitral regurgitation between 1974 and 1979. There were 4 in-hospital deaths (4 percent) and 12 late deaths giving an 82 percent predicted 5 year survival rate. An age of 60 years or more at the time of surgery and a preoperative left ventricular ejection fraction of less than 0.40 were the only variables that correlated with decreased survival at 3 to 5 years after operation (p< 0.05). Postoperatively, 87 (98 percent) of 89 long-term survivors were in New York Heart Association functional class I or II (68 in class I and 19 in class II). Survival did not differ between patients with porcine versus mechanical valve replacement, but patients with a mechanical valve had a greater incidence of postoperative cerebrovascular accident (8.6 100 patient years) than did patients with a porcine valve (2.8/100 patient years)(p< 0.002). Ejection fraction at rest was determined with multigated cardiac imaging 12 to 75 months post-operatively in 34 of 89 long-term survivors. The mean preoperative ejection fraction was 0.62±0.09 (mean±1 standard deviation) and the mean postoperative ejection fraction was 0.50±0.15 (p< 0.001). When the preoperative value was compared with the postoperative value at rest the ejection fraction increased by 0.10 or more in 1 patient (3 percent), remained within±0.09 of the preoperative value in 12 patients (35 percent) and decreased by 0.10 or greater in 21 patients (62 percent). Sixteen (94 percent) of 17 patients whose postoperative ejection fraction was greater than 0.50 were in functional class I postoperatively compared with 11 (65 percent) of 17 patients whose postoperative ejection fraction was 0.50 or less (p< 0.05). No preoperative factor, including preoperative ejection fraction or cardiothoracic ratio, predicted the postoperative ejection fraction. A postoperative exercise ejection fraction was obtained in 29 patients, and an abnormal ejection fraction change with exercise (increase< 0.05) was observed in 20 patients (69 percent). Patient age at the time of study correlated inversely with the change in ejection fraction from rest to exercise; no other variables were predictive. It is concluded that, in addition to age, only preoperative left ventricular function as measured by ejection fraction predicts survival in patients undergoing mitral valve replacement for isolated mitral regurgitation. Clinical recovery is good even though the majority of long-term survivors have a postoperative decrease in ejection fraction.