老年风湿性二尖瓣病变行二尖瓣修复术与生物瓣膜置换术中期效果比较

目的比较60岁以上老年患者风湿性二尖瓣修复(MVP)与生物瓣膜置换(MVR)的中期效果。方法选取2014年1月至2016年1月北京安贞医院瓣膜外科诊疗中心行风湿性二尖瓣修复或生物瓣置换手术的60岁以上老年风湿性二尖瓣病变患者,包括同期行三尖瓣修复术及房颤射频消融术患者;排除合并主动脉瓣手术、冠状动脉旁路移植手术、二次手术患者,最终纳入患者82例。根据二尖瓣手术方式分为二尖瓣修复组(MVP组,25例)和生物瓣置换组(MVR组,57例)。采用Kaplan-Meier法进行生存分析并绘制曲线,通过Log Rank方法比较两组患者5年生存率的差异。结果围手术期全组患者平均年龄(66.37±4.41)岁。54.9%的患者心功能(NYHA分级)Ⅲ级。两组患者在体外循环时间(P=0.99),主动脉阻断时间(P=0.88),术后住院时间(P=0.76)差异均无统计学意义。MVR组3例患者住院期间死亡,病死率5.3%;MVP组无住院期死亡(P=0.24)。随访5年,最长随访63个月,平均随访47.03个月。MVR组6例死亡,其中4例死于心脑血管不良事件,2例死于非心脑血管不良事件。MVP组无死亡。两组均无再手术病例。结论风湿性二尖瓣病变的老年患者采用二尖瓣修复手术治疗能够获得较好的中期效果。

Mitral repair or bioprosthetic replacement for rheumatic valve drseascs in elderly patients

Objective Mitral valve replacement is more frequently performed in elder patients with rheumatic valve diseases.Mitral valve repair may be feasible in young patients with suitable anatomy in rheumatic mitral valve disease,but still controversial in elder patients.Our study was to compare mitral repair to bioprosthetic replacement in patients aged 60 years or older.Methods Eighty two patients(age≥60 years)underwent mitral valve surgery(mitral repair or bioprosthetic replacement)in our single institution from January 2014 to January 2016 were reviewed,including 25 cases of repair(MVP)and 57 cases of bioprosthetic replacement(MVR).5 years follow-up oganalysis.Results Mean age in MVP and MVR was 64.43 years and 67.28 years,respectively.There were no statistically differences in extracorporeal circulation time(P=0.99)and aorta blocking time(P=0.88);the operative mortality rate in MVR was 5.3%while none in MVP(P=0.24).During follow-up 6 deaths happened in MVR,4 of them died from MACE while the other 2 died from other causes.There was no death in MVP(P=0.17).No redo or other complications were found during follow-up.Conclusion In patients aged 60 years or older with rheumatic mitral valve disease,mitral repair is associated with a same perioperative and mid-term result compared with bioprosthetic replacement.Rheumatic mitral valves could be repaired in elderly patients.