瓣叶切除与人工腱索治疗单纯二尖瓣后叶脱垂的病例对照研究

目的 比较单纯二尖瓣后叶脱垂应用瓣叶切除或人工腱索技术行二尖瓣成形术的手术效果。 方法 2010年12月至2013年12月， 384例患者病因单纯二尖瓣后叶脱垂导致的二尖瓣反流于我科行二尖瓣成形术，其中单纯人工腱索者33例（8.6%）、单纯瓣叶切除者258例（67.2%）。应用倾向评分匹配进行配对，分为人工腱索组（n=32）与瓣叶切除组（n=32），并进行比较。回顾性分析两组围手术期情况及术后随访结果。结果 倾向评分匹配后人工腱索组和瓣叶切除组的各项术前指标无统计学差异。两组均顺利完成手术，无围手术期死亡。两组体外循环时间、主动脉阻断时间均有统计学差异（P=0.009、0.013）。人工腱索组使用较大二尖瓣成形环更多（P=0.019）。两组出院前左室射血分数（LVEF）、舒张期二尖瓣跨瓣峰值压差（TMG）均无统计学差异。平均随访（31.8±11.9）个月，两组患者生存、再次手术、≥中度二尖瓣反流、舒张期二尖瓣跨瓣峰值压差、再次手术均无统计学差异，但人工腱索组LVEF为（66.0±4.1）%，瓣叶切除组LVEF为（61.5±5.9）%，两组间有统计学差异（P=0.007）。 结论 人工腱索技术和瓣叶切除技术都可以有效地修复二尖瓣后叶脱垂。人工腱索技术与瓣叶切除技术相比更有利于术后左室功能，但两种技术在术后生存及二尖瓣反流情况上并无差异。

Artificial chordae versus leaflet resection for isolated posterior mitral valve prolapse: a propensity score matched study

Objective To compare outcomes of artificial chordae versus leaflet resection techniques for repair of isolated posterior mitral leaflet prolapse. Methods From Dec. 2010 to Dec. 2013, a total of 384 mitral valve repairs for isolated posterior leaflet were carried out at our hospital. Of these patients, 33 cases underwent isolated artificial chordae replacement and 258 cases underwent isolated leaflet resection. The propensity score was used to create matched artificial chordae (n = 32) and leaflet resection (n = 32) cohorts. Results There were no significant differences in the preoperative profiles after propensity score matching. There was no peri-operative mortality. The cardiopulmonary bypass time and cross-clamp time was significantly different between the 2 groups (P=0.009 & 0.013, respectively). More large-size annuloplasty ring were used (P=0.019) in the artificial chordae group, but there was no significant in peak transmitral gradient (TMG). There was no significant difference in mortality, re-operation or recurrent mitral regurgitation during follow-up of (31.8±11.9) months. At the last echocardiography, the peak TMG was similar while the left ventricular ejection fraction (LVEF) was significantly different (P=0.007) between the 2 groups. Conclusion We demonstrated good midterm results for both artificial chordae and leaflet resection techniques for repair of isolated posterior mitral leaflet prolapse. No significant difference was found in mortality, re-operation or recurrent mitral regurgitation during mid-term follow-up, although in the artificial chordae technique result in better LVEF.