Durability of mitral valve repair for degenerative disease
Durability of mitral valve repair for degenerative disease
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DOI：
10.1016/s0022-5223(98)00450-4
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发表时间：
1998-11-01
影响因子：
6
通讯作者：
Loop, FD
中科院分区：
文献类型：
--
作者：
Gillinov, AM;Cosgrove, DM;Loop, FD
背景：退行性二尖瓣疾病是美国二尖瓣反流最常见的原因。二尖瓣修复术适用于大多数此类患者，并已成为首选手术方法。目的：探讨影响二尖瓣修复耐久性的因素。患者和方法：1985年至1997年间，1072例患者因退行性疾病引起的二尖瓣反流接受了初级分离二尖瓣修复。通过多变量风险因素分析评估再手术的修复耐久性。在再次手术前对与瓣膜相关的死亡危险因素进行研究。发生3例医院死亡（0.3%）；1069名医院幸存者中的1062名（99.3%）获得了完全随访（4152例患者年）。结果：术后10年再手术成功率为93%。30例晚期二尖瓣功能不全需要再手术的患者？由于进行性退行性疾病，16例（53%）修复失败。除后小叶脱垂、使用脊索缩短术、单独行环成形术和不行环成形术的后小叶切除外，病理条件对修复的持久性有不利影响。四边形切除和后小叶脱垂环成形术后的持久性最大，术中超声心动图的使用增强了持久性。单纯前小叶脱垂或瓣膜钙化的患者再手术前死亡率增加，单纯使用脊索缩短或环成形术。结论：孤立性后小叶脱垂患者行后小叶切除术和环成形术的修复耐久性最大，脊索缩短、单独环成形术和切除小叶而不做环成形术会危及后期效果。
Background: Degenerative mitral valve disease is the most common cause of mitral regurgitation in the United States. Mitral valve repair is applicable in the majority of these patients and has become the procedure of choice. Objective: This study was undertaken to identify factors influencing the durability of mitral valve repair. Patients and Methods: Between 1985 and 1997, 1072 patients underwent primary isolated mitral valve repair for valvular regurgitation caused bg degenerative disease. Repair durability was assessed by multivariable risk factor analysis of reoperation. It was supplemented by a search for valve-related risk factors for death before reoperation. Three hospital deaths occurred (0.3%); complete follow-up (4152 patient-years) was available in 1062 of 1069 hospital survivors (99.3%). Results: At 10 years, freedom from reoperation was 93%. Among 30 patients who required reoperation for late mitral valve dysfunction? the repair failed in 16 (53%) as a result of progressive degenerative disease. Durability of repair was adversely affected by pathologic conditions other than posterior leaflet prolapse, use of chordal shortening, annuloplasty alone, and posterior leaflet resection without annuloplasty. Durability was greatest after quadrangular resection and annuloplasty for posterior leaflet prolapse and was enhanced by the use of intraoperative echocardiography, Death before reoperation was increased in patients having isolated anterior leaflet prolapse or valvular calcification and by use of chordal shortening or annuloplasty alone. Conclusions: Repair durability is greatest in patients with isolated posterior leaflet prolapse who have posterior leaflet resection and annuloplasty, Chordal shortening, annuloplasty alone, and leaflet resection without annuloplasty jeopardize late results.