Hemolysis after mitral valve repair: Mechanisms and treatment
Hemolysis after mitral valve repair: Mechanisms and treatment
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DOI：
10.1016/s0003-4975(03)01455-3
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发表时间：
2004-01-01
影响因子：
4.6
通讯作者：
Gillinov, AM
中科院分区：
文献类型：
--
作者：
Lam, BK;Cosgrove, DM;Gillinov, AM
背景。本研究的目的是确定二尖瓣修复术后溶血的机制，并确定手术治疗（二尖瓣置换或再修复）后的结果。方法。 1981 年至 2002 年间，32 名患者（平均年龄 58 岁）因退行性、风湿性或缺血性二尖瓣反流 (MR) 进行二尖瓣修复术后出现溶血性贫血。最初的二尖瓣修复术使用了三种类型的瓣环成形术：Cosgrove-Edwards、Carpentier-Edwards 和牛心包 (Perigard)。通过实验室检查和超声心动图检查溶血的诊断和机制。结果。从初次二尖瓣手术到溶血诊断的中位间隔为 3 个月（范围为 1 周至 4 年）。就诊时，平均血细胞比容为 27.5%+/-4.9%，22 名患者 (69%) 需要输血。超声心动图检查结果各不相同。 24 名患者 (77%) 的 MR 为 3 级或 4 级。二尖瓣反流射流类型包括碎裂（11 例，34%）、加速（10 例，31%）、缓慢减速（5 例，16%）、碰撞（4 例，13%）和自由射流（2 例，6%）。 28例患者行二尖瓣置换术，3例患者再次修复二尖瓣，1例患者未再次手术。再次手术时，31 名患者中有 25 名 (81%) 的二尖瓣修复完好。再次手术患者中有 2 例住院死亡（6%）。 1 年精算生存率为 95%，5 年精算生存率为 85%。 1 名患者因二尖瓣置换术后瓣周漏引起复发性机械性溶血。结论。溶血是二尖瓣修复失败的一种模式。溶血患者通常在二尖瓣修复术后 3 个月内出现。尽管超声心动图特征各不相同，但大多数患者具有高级别 MR 和破碎或加速的反流射流。二尖瓣置换术为二尖瓣修复后发生溶血的患者带来了良好的结果。
Background. The objectives of this study were to determine the mechanisms of hemolysis after mitral valve repair and to determine outcomes after surgical treatment (mitral replacement or re-repair).Methods. Between 1981 and 2002, 32 patients (mean age, 58 years) presented with hemolytic anemia after mitral valve repair for degenerative, rheumatic, or ischemic mitral regurgitation (MR). Three types of annuloplasty were used at the initial mitral valve repair: Cosgrove-Edwards, Carpentier-Edwards, and bovine pericardial (Perigard). The diagnosis and the mechanisms of hemolysis were investigated with laboratory testing and echocardiography.Results. Median interval from initial mitral valve surgery to diagnosis of hemolysis was 3 months (range, 1 week to 4 years). At presentation, mean hematocrit was 27.5%+/-4.9% and 22 patients (69%) required transfusion. Echocardiographic findings varied. Twenty-four patients (77%) had grade 3 or 4 MR. Mitral regurgitant jet types included fragmentation (11 patients, 34%), acceleration (10, 31%), slow deceleration (5, 16%), collision (4, 13%), and free jet (2, 6%). Mitral valve replacement was performed in 28 patients, mitral valve re-repair in 3, and 1 patient did not undergo reoperation. At reoperation the mitral valve repair was physically intact in 25 of 31 patients (81%). There were 2 hospital deaths in patients having reoperation (6%). Actuarial survival was 95% at 1 year and 85% at 5 years. In 1 patient recurrent mechanical hemolysis developed caused by a perivalvular leak after mitral valve replacement.Conclusions. Hemolysis is a mode of failure of mitral valve repair. Patients with hemolysis generally present within 3 months of mitral valve repair. Although echocardiographic features varied, most patients had high-grade MR and regurgitant jets that fragmented or accelerated. Mitral valve replacement yields favorable outcomes for patients with hemolysis after mitral valve repair.