二尖瓣修复技术治疗非缺血性二尖瓣返流的临床效果

刘兴荣; 张超纪; 刘剑州; 苗齐; 马国涛; 曹丽华; 李晓凤

doi:10.3969/j.issn.1674-9081.2014.04.017

二尖瓣修复技术治疗非缺血性二尖瓣返流的临床效果

Clinical Outcome of Mitral Valve Repair for Non-ischemic Mitral Regurgitation

摘要

摘要:
目的总结二尖瓣修复技术用于治疗非缺血性二尖瓣返流的临床效果。
方法回顾分析北京协和医院2001年1月至2012年12月行二尖瓣成形术的连续104例非缺血性二尖瓣返流患者的临床资料。其中男性58例, 女性46例, 平均年龄(45.3±16.8)岁(9~77岁), 均在体外循环下择期行二尖瓣成形术, 采取适当方法修复瓣叶, 并放置相应型号的人工瓣环。
结果术中修复成功率96.2%(100/104)。术后1例患者死于多器官功能衰竭, 死亡率0.96%。1例患者手术后发生肾功能衰竭需要短暂肾替代治疗。中位随访时间46个月(8~141个月), 失访8例。随访期间1例患者死于肿瘤, 二尖瓣返流复发加重3例, 其中2例再次手术行二尖瓣置换。免于二尖瓣返流率为96.7%(88/91), 免于再次手术率为97.8%(89/91)。
结论二尖瓣成形术应作为治疗非缺血性二尖瓣返流的首选术式。采取适当的修复技术, 可以获得满意的近远期效果。

Abstract:
Objective To evaluate the clinical outcome of mitral valve repair for non-ischemic mitral regurgitation.
Methods We reviewed the clinical data of 104 consecutive patients with non-ischemic mitral regurgitation who underwent elective mitral valvuloplasty from January 2001 to December 2012 in Peking Union Medical College Hospital. The enrolled patients included 58 men and 46 women, aged (45.3±16.8)years (range, 9-77 years). The surgical procedures were elective mitral valvuloplasty with cardiopulmonary bypass, during which the mitral leaflets were repaired and annuloplastic rings of appropriate sizes were implanted.
Results The success rate of surgery was 96.2% (100/104). One patient died postoperatively due to multiple organ failure (mortality 0.96%). One patient developed renal failure which mandated transient renal replacement therapy. The median follow-up time was 46 months(range, 8-141 months) and 8 patients were lost. One late death occurred due to neoplasia. Three patients suffered relapse of mitral regurgitation, of whom two underwent mitral replacement. The rate of freedom from mitral regurgitation was 96.7% (88/91), and the rate of freedom from re-operation was 97.8% (89/91).
Conclusions With satisfactory short- and long-term outcomes, mitral valvuloplasty could be the primary treatment for non-ischemic mitral regurgitation.

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