二尖瓣修复技术治疗非缺血性二尖瓣返流的临床效果

  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。

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

Objective To evaluate the clinical outcome of mitral valve repair for non-ischemic mitral re-gurgitation .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 thera -py.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 reoperation 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 .