Ten-year experience of chordal replacement with expanded polytetrafluoroethylene in mitral valve repair.
Ten-year experience of chordal replacement with expanded polytetrafluoroethylene in mitral valve repair.
复制标题
膨体聚四氟乙烯腱索置换修复二尖瓣十年经验。
作者：
Junjiro Kobayashi;Y. Sasako;Ko Bando;K. Minatoya;K. Niwaya;Soichiro Kitamura
背景
二尖瓣修复术是纠正二尖瓣反流 (MR) 的首选手术。尽管膨胀聚四氟乙烯 (ePTFE) 腱索置换术已被广泛接受用于修复二尖瓣前脱垂和其他困难情况，但修复的长期结果和 ePTFE 的命运尚未确定。
方法和结果
从1988年7月到1999年4月，74名年龄17至77岁（平均年龄55. 3+/-14.8岁）的患者（49名男性，25名女性）接受了二尖瓣修复和ePTFE腱索置换术。随访时间为6个月至11. 3年（平均4.6+/-3.2年）。 65 名患者 (88%) 的 MR 病因为退行性病变，9 例 (12%) 患者的 MR 病因为感染性。三名患者患有活动性感染性心内膜炎。 35 名患者存在前瓣膜病变，10 名患者存在后瓣膜病变，29 名患者存在前后瓣膜病变。37 名患者 (50%) 需要进行各种瓣叶成形术。 38 名患者 (51%) 伴有心房颤动，自 1992 年 7 月以来，已在选定的 30 名患者 (41%) 组中进行了迷宫手术。其中有 1 例院内死亡 (1.4%) 和 3 例晚期心源性死亡 (4.1%)。随访期间，12 名患者 (17%) 出现中度以上 MR。其中 3 名患者因溶血需要在 1 年内进行早期再次手术。两名患者分别在修复后 6 年和 8 年接受了二尖瓣置换术。 5年和10年的精算无再次手术率分别为94.3+/-2.8%和81.7+/-9.1%。通过迷宫手术，21 名患者 (70%) 恢复了窦性心律。未接受迷宫手术的房颤患者仅发生 1 次血栓栓塞发作（0. 3%/患者-y）。根据 5 年和 10 年无心源性死亡、血栓栓塞、再次手术和抗凝相关出血的情况评估，无事件生存率为 91.3+/-3。分别为 4% 和 71.6+/-9.7%。复发性 MR 与 ePTFE 的变化之间没有关系。再次手术期间切除的 ePTFE 的结构分析显示没有钙化，并显示出剩余的灵活性和柔韧性。在 ePTFE 中观察到蛋白质浸润，并且在瓣膜小叶和乳头肌的固定部位发现胶原增生。 ePTFE 表面完全内皮化，可能具有抗血栓形成作用。
结论
ePTFE 作为人工腱索用于 MR 二尖瓣修复的长期耐用性和生物适应性已被证明超过 10 年。
BACKGROUND
Mitral valve repair is the procedure of choice to correct mitral regurgitation (MR). Although chordal replacement with expanded polytetrafluoroethylene (ePTFE) has been widely accepted to repair anterior mitral prolapse and other difficult situations, the long-term results of the repair and the fate of ePTFE have not been delineated.
METHODS AND RESULTS
From July 1988 to April 1999, 74 patients (49 males, 25 females) aged 17 to 77 years (mean age 55. 3+/-14.8 years) underwent mitral valve repair with chordal replacement with ePTFE. The follow-up period was from 6 months to 11. 3 years (mean 4.6+/-3.2 years). The causes of MR were degenerative in 65 patients (88%) and infective in 9 (12%). Three patients had active infective endocarditis. Valve lesions were anterior in 35 patients, posterior in 10, and both anterior and posterior in 29. Various procedures for plasty of leaflets were necessary in 37 patients (50%). Atrial fibrillation was associated in 38 patients (51%), and the maze procedure has been performed in a selected group of 30 patients (41%) since July 1992. There was 1 in-hospital death (1.4%) and 3 late cardiac deaths (4.1%). More than moderate MR developed in 12 patients (17%) during the follow-up period. Three of these patients required early reoperation within 1 year due to hemolysis. Two patients underwent mitral valve replacement at 6 and 8 years after repair, respectively. The actuarial reoperation-free rates at 5 and 10 years were 94.3+/-2.8% and 81.7+/-9.1%, respectively. Sinus rhythm was restored in 21 patients (70%) with the maze procedure. There was only 1 thromboembolic episode (0. 3%/patient-y) in a patient with atrial fibrillation who did not undergo the maze procedure. Event-free survival rates as assessed by the freedom from cardiac death, thromboembolism, reoperation, and anticoagulation-related hemorrhage at 5 and 10 years were 91.3+/-3. 4% and 71.6+/-9.7%, respectively. There was no relationship between recurrent MR and the change of ePTFE. Structural analysis of the ePTFE resected during reoperation revealed no calcification and showed remaining flexibility and pliability. Protein infiltration was observed in the ePTFE, and collagenous proliferation was recognized at the site of fixation to the valve leaflet and the papillary muscle. The surface of the ePTFE was completely endothelialized, which may induce antithrombogenicity.
CONCLUSIONS
The long-term durability and biological adaptation of ePTFE as artificial chordae for mitral valve repair of MR were proved for >10 years.
影响因子：
9
作者：
Cox, JL;Schuessler, RB;Boineau, JP
通讯作者：
Boineau, JP