Recent developments and evolving techniques of mitral valve reconstruction
Recent developments and evolving techniques of mitral valve reconstruction
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DOI：
10.1016/s0003-4975(97)01101-6
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发表时间：
1998-02-01
影响因子：
4.6
通讯作者：
Colvin, SB
中科院分区：
文献类型：
--
作者：
Spencer, FC;Galloway, AC;Colvin, SB
总结了纽约大学18年来1,000例二尖瓣重建术的经验。持续随访（98%完成）表明，88%的患者在术后10年没有复发性功能不全。近90%的二尖瓣脱垂患者可以进行重建，手术死亡率接近2%。因此，现在建议在患者仍处于窦性心律时，在左心室收缩功能障碍的早期症状时进行手术。大多数手术都是采用Carpentier技术进行的，即节段切除、瓣环成形术和插入Carpentier环。最近，已经对另外两种修复技术和微创手术方法进行了评价。三角形切除脱垂的前叶已在100多名患者中进行了良好的结果。此外，在40多名后叶较大的患者中采用了后叶“折叠成形术”，最大限度地减少了对瓣环折叠的需要。在过去一年中，130例患者采用了微创二尖瓣入路，使用右小切口和Port-Access（Heartport，Inc，门洛帕克，CA）入路。该技术采用经股血管引入的导管来建立心肺转流和心脏停搏。二尖瓣重建手术的手术方法和技术不断发展，具有良好的结果和改善的患者受益。
Experiences with 1,000 patients undergoing mitral valve reconstruction at New York University over the past 18 years are summarized. A continuing follow-up (98% complete) demonstrated that 88% of patients are free from recurrent insufficiency 10 years after the operation. Reconstruction is feasible in nearly 90% of patients with mitral valve prolapse, with an operative mortality near 2%. Accordingly operation is now recommended at an early stage with the first sign of left ventricular systolic dysfunction, while the patient is still in sinus rhythm. Most operations have been done with the Carpentier techniques of segmental resection with annuloplasty and insertion of a Carpentier ring. Recently, two other repair techniques and a minimally invasive operative approach have been evaluated. A triangular resection of a prolapsing anterior leaflet has been done in more than 100 patients with excellent results. Also, a posterior "folding plasty" has been employed in more than 40 patients with a large redundant posterior leaflet, minimizing the need for annular plication. A minimally invasive approach to the mitral valve has now been employed in 130 patients over the past year, using a right mini-thoracotomy and the Port-Access (Heartport, Inc, Menlo Park, CA) approach. This technique employs catheters introduced through femoral vessels to institute cardiopulmonary bypass and cardioplegic arrest. The operative approach and techniques for mitral valve reconstructive operations continue to evolve, with excellent results and improved patient benefits.