SEVERE CALCIFICATION DOES NOT AFFECT LONG-TERM OUTCOME OF MITRAL-VALVE REPAIR
SEVERE CALCIFICATION DOES NOT AFFECT LONG-TERM OUTCOME OF MITRAL-VALVE REPAIR
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DOI：
10.1016/0003-4975(94)90728-5
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发表时间：
1994-09-01
影响因子：
4.6
通讯作者：
COLVIN, SB
中科院分区：
文献类型：
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作者：
GROSSI, EA;GALLOWAY, AC;COLVIN, SB
一些外科医生认为二尖瓣环或瓣叶中存在严重钙化会妨碍修复的成功。当通过瓣环清创和瓣叶切除可以实现良好的瓣环和瓣叶活动性时，我们的机构尝试修复这些钙化瓣膜。从 1979 年 6 月到 1993 年 6 月，使用 Carpentier 的技术进行了 558 例二尖瓣修复手术。当遇到钙化瓣膜时，这些技术被修改为包括环形清创术和机械小叶脱钙术。术前通过左心室透视或超声心动图发现 49 名患者 (8.8%) 存在钙化，64 名患者 (11.5%) 进行了清创。这包括 24 例环状清创术、28 例小叶清创术以及 12 例环状和小叶清创术。患者年龄范围为 13 至 83 岁（平均年龄 62.3 岁），25 名患者（39.1%，25/64）同时接受过心脏手术。总体手术死亡率为 6.2% (4/64)，孤立二尖瓣修复术的手术死亡率为 2.6% (1/39)。风湿病患者中 19.3% (23/119) 进行了钙清创，而非风湿病患者中这一比例为 9.3% (41/439) (p < 0.01)。长期随访显示，接受钙清创术的患者中有 7.8% (5/64) 需要再次手术，而未进行清创术的患者中有 7.7% (38/494) 需要再次手术（p = 不显着）。所有患者 10 年累积免再次手术率为 83.3%，清创患者为 88.1%，未清创患者为 82.6%（p = 不显着）。 Cox比例风险分析显示，风湿病的存在显着增加了再次手术的风险（比值比= 3.28；p < 0.001），而钙清创没有显着影响。这些结果表明，当钙化二尖瓣能够实现良好的瓣环和小叶运动时，钙清创术可以实现持久修复。
Some surgeons have suggested that the presence of severe calcification in the mitral valve annulus or leaflets precludes successful repair. Our institution has attempted to repair these calcified valves when good annular and leaflet mobility could be achieved by annular debridement and leaflet resection. From June 1979 through June 1993 558 mitral valve repairs were performed using Carpentier's techniques. When calcified valves were encountered, these techniques were modified to include annular debridement and mechanical leaflet decalcification. Calcification was identified preoperatively in 49 patients (8.8%) by either left ventricular fluoroscopy or echocardiography and was debrided in 64 patients (11.5%). This included 24 annular debridements, 28 leaflet debridements, and 12 annular and leaflet debridements. Patient ages ranged from 13 to 83 years (mean age, 62.3 years), and 25 patients (39.1%, 25/64) had concomitant cardiac procedures. Operative mortality was 6.2% (4/64) overall and 2.6% (1/39) for isolated mitral valve repairs. Calcium debridement was performed in 19.3% (23/119) of patients with a rheumatic cause compared with 9.3% (41/439) of the nonrheumatic patients (p < 0.01). Long-term follow-up revealed the necessity for reoperation in 7.8% (5/64) in patients with calcium debridement as compared with 7.7% (38/494) with no debridement (p = not significant). Cumulative freedom from reoperation at 10 years was 83.3% for all patients, 88.1% for debrided patients, and 82.6% for nondebrided patients (p = not significant). Cox proportional hazards analysis revealed that the presence of rheumatic disease significantly increased the risk of reoperation (odds ratio = 3.28; p < 0.001), whereas calcium debridement had no significant effect. These results demonstrate that when good annulus and leaflet motion can be achieved in calcified mitral valves, calcium debridement allows durable repairs.