Degenerative mitral valve regurgitation: best practice revolution.
Degenerative mitral valve regurgitation: best practice revolution.
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DOI：
10.1093/eurheartj/ehq222
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发表时间：
2010-08
影响因子：
39.3
通讯作者：
Falk V
中科院分区：
文献类型：
--
作者：
Adams DH;Rosenhek R;Falk V
退行性二尖瓣疾病常因腱索伸长或破裂而导致小叶脱垂，并导致二尖瓣关闭不全。手术干预的转诊指南主要集中在症状和心室功能障碍上。退行性二尖瓣疾病的推荐治疗方法是二尖瓣重建，而不是用生物瓣膜或机械瓣膜置换，因为瓣膜修复与改善无事件生存相关。最近的研究表明，大量患者没有按照既定指南及时转诊，当他们接受手术时，数量惊人的患者继续接受二尖瓣置换术。关于无症状严重二尖瓣反流的适当干预时机的争论更加强调有针对性的外科医生转诊以及确保极高二尖瓣修复率的必要性，特别是在非老年人群中。目前的临床实践对于许多患者来说仍然不够理想，本次综述探讨了退行性二尖瓣反流领域进行“最佳实践革命”的必要性。
Degenerative mitral valve disease often leads to leaflet prolapse due to chordal elongation or rupture, and resulting in mitral valve regurgitation. Guideline referral for surgical intervention centres primarily on symptoms and ventricular dysfunction. The recommended treatment for degenerative mitral valve disease is mitral valve reconstruction, as opposed to valve replacement with a bioprosthetic or mechanical valve, because valve repair is associated with improved event free survival. Recent studies have documented a significant number of patients are not referred in a timely fashion according to established guidelines, and when they are subjected to surgery, an alarming number of patients continue to undergo mitral valve replacement. The debate around appropriate timing of intervention for asymptomatic severe mitral valve regurgitation has put additional emphasis on targeted surgeon referral and the need to ensure a very high rate of mitral valve repair, particularly in the non-elderly population. Current clinical practice remains suboptimal for many patients, and this review explores the need for a ‘best practice revolution’ in the field of degenerative mitral valve regurgitation.