A simplified approach to degenerative disease: Triangular resections of the mitral valve
A simplified approach to degenerative disease: Triangular resections of the mitral valve
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DOI：
10.1016/j.athoracsur.2007.01.028
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发表时间：
2007-05-01
影响因子：
4.6
通讯作者：
Kron, Irving L.
中科院分区：
文献类型：
--
作者：
Gazoni, Leo M.;Fedoruk, Lynn M.;Kron, Irving L.
背景只有40%的二尖瓣（MV）返流患者接受手术修复而不是置换。四边形切除联合瓣环成形术是退行性后叶疾病最常见的修复方法。滑动瓣环成形术和人工腱索使用等技术增加了修复的复杂性。这些技术被认为是困难的，并可能降低MV修复的发生率。我们提出了我们的经验，一个简化的方法，MV修复利用三角切除和更大的环。对7年期间（1999年至2006年）的所有二尖瓣修复进行回顾性审查，发现154例患者因退行性疾病接受三角切除术。排除了未行瓣叶切除的瓣环成形术患者和行人工腱索或四边形切除术的患者。在接受三角形切除术的154例患者中，130例患者接受了孤立后叶切除术。分别对16名和8名患者进行了单独的前叶和前后叶联合三角切除术。术后30天死亡率为0%。5年无二尖瓣返流复发再手术率为99.0%。没有计划切除瓣叶的患者转为二尖瓣置换术。术中经食管超声心动图显示微量至1 +二尖瓣返流。7.1%的病例最初出现轻度收缩期前向运动，但所有病例均在容量负荷后消退。二尖瓣三角瓣叶切除术可产生持久的结果，并且可以安全有效地进行，发病率和死亡率最低。该技术应能增加二尖瓣修复术在退行性疾病中的应用。
Background. Only 40% of patients with mitral valve (MV) regurgitation undergo operative repair rather than replacement. Quadrangular resection combined with ring annuloplasty has been the most common method of repair for degenerative posterior leaflet disease. Techniques such as sliding annuloplasty and artificial chord usage have increased the complexity of repair. These techniques have been perceived to be difficult and have possibly reduced the incidence of MV repair. We present our experience with a simplified approach to MV repair utilizing a triangular resection and larger rings.Methods. Retrospective review of all MV repairs over a 7-year period (1999 to 2006) revealed 154 patients who underwent triangular resection for degenerative disease. Patients who underwent ring annuloplasty without leaflet resection and patients who had artificial chords or quadrangular resections were excluded.Results. Of 154 patients who underwent triangular resection, isolated posterior leaflet resection was performed on 130 patients. Isolated anterior and combined anterior and posterior leaflet triangular resections were performed on 16 and 8 patients, respectively. Thirty-day postoperative mortality was 0%. Five-year freedom from reoperation for recurrent mitral regurgitation was 99.0%. No patients who had intended leaflet resection were converted to MV replacement. Intraoperative transesophageal echocardiogram revealed trace to 1 + mitral regurgitation. Mild systolic anterior motion was noted in 7.1% of cases initially, but resolved with volume loading in all.Conclusions. Triangular leaflet resection of the mitral valve produces durable results and can be safely and efficiently performed with minimal morbidity and mortality. This technique should allow increased utilization of MV repair for degenerative disease.