EARLY OUTCOME OF MITRAL-VALVE RECONSTRUCTION IN PATIENTS WITH END-STAGE CARDIOMYOPATHY
EARLY OUTCOME OF MITRAL-VALVE RECONSTRUCTION IN PATIENTS WITH END-STAGE CARDIOMYOPATHY
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DOI：
10.1016/s0022-5223(95)70348-9
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发表时间：
1995-04-01
影响因子：
6
通讯作者：
BACH, DS
中科院分区：
文献类型：
--
作者：
BOLLING, SF;DEEB, GM;BACH, DS
无法控制的严重二尖瓣反流是终末期心肌病的常见并发症，在这些患者中显著导致心力衰竭，并预示着较差的生存率。尽管消除二尖瓣反流可能对这组患者最有益，但由于假定手术死亡率过高，矫正二尖瓣手术并未在这些病情严重的患者中常规进行。我们研究了1993年6月至1994年4月期间连续16例心肌病和严重难治性二尖瓣反流患者的二尖瓣重建术的早期结果，男性11例，女性5例，年龄44 ~ 78岁（64 +/- 8岁），左心室射血分数为9% ~ 25%(16% +/- 5%)，术前所有患者均为纽约心脏协会IV级。重度二尖瓣返流（经食管彩色多普勒超声分级0 ~ 4+），2例列入移植名单。4例患者因偶发冠心病行单次冠状动脉旁路移植术，4例患者因既往行冠状动脉旁路移植术行右开胸手术，4例患者因严重三尖瓣反流行三尖瓣重建，无患者需要主动脉内球囊泵支持。没有手术或医院死亡和平均住院天数10天,有三个晚期死亡,6和7个月后二尖瓣重建,及1年精算生存一直是75%,平均8个月的随访中,所有剩余的患者在纽约心脏协会类I或II,平均术后射血分数25% + / - 10%,没有住院治疗充血性心力衰竭,和减少药物需要指出,对于患有心肌病和严重二尖瓣反流的患者，二尖瓣重建术相对于置换术可以降低手术死亡率和早期死亡率。尽管长期随访是强制性的，但二尖瓣重建术可能为终末期心肌病和严重二尖瓣反流患者提供新的策略，从而改善症状状态和生存率。
Uncontrollable severe mitral regurgitation is a frequent complication of end-stage cardiomyopathy, significantly contributing to heart failure in these patients, and predicts a poor survival, Although elimination of mitral valve regurgitation could be most beneficial in this group, corrective mitral valve surgery has not been routinely undertaken in these very ill patients because of the presumed prohibitive operative mortality, We studied the early outcome of mitral valve reconstruction in 16 consecutive patients with cardiomyopathy and severe, refractory mitral regurgitation operated on between June 1993 and April 1994, There were 11 men and five women, aged 44 to 78 years (64 +/- 8 years) with left ventricular ejection fractions of 9% to 25% (16% +/- 5%), Preoperatively all patients were in New York Heart Association class IV, had severe mitral regurgitation (graded 0 to 4+ according to color flow Doppler transesophageal echocardiography) and two were listed for transplantation. Operatively, a flexible annuloplasty ring was implanted in all patients, Four patients also had single coronary bypass grafting for incidental coronary disease, In four patients the operation was performed through a right thoracotomy because of prior coronary bypass grafting, and four patients also underwent tricuspid valve reconstruction for severe tricuspid regurgitation, No patient required support with an intraaortic balloon pump, There were no operative or hospital deaths and mean hospital stay was 10 days, There were three late deaths at 2, 6, and 7 months after mitral valve reconstruction, and the 1-year actuarial survival has been 75%, At a mean follow-up of 8 months, all remaining patients are in New York Heart Association class I or II, with a mean postoperative ejection fraction of 25% +/- 10%, There have been no hospitalizations for congestive heart failure, and a decrease in medications required has been noted, For patients with cardiomyopathy and severe mitral regurgitation, mitral valve reconstruction as opposed to replacement can be accomplished with low operative and early mortality, Although longer term follow-up is mandatory, mitral valve reconstruction may allow new strategies for patients with end-stage cardiomyopathy and severe mitral regurgitation, yielding improvement in symptomatic status and survival.