限制性二尖瓣环成形联合冠状动脉旁路移植术治疗缺血性二尖瓣反流

目的 探讨限制性二尖瓣环成形联合冠状动脉旁路移植术(CABG)治疗缺血性二尖瓣反流的近、中期效果及其在逆转左心室重构中的作用.方法 2000年1月至2008年6月,111例伴有中重度缺皿性二尖瓣反流的冠状动脉粥样硬化性心脏病患者接受限制性二尖瓣环成形联合CABG.男性81例,女性30例;平均年龄(63±18)岁.术前经胸超声心动图示二尖瓣反流中度7例,中重度65例,重度39例.比较患者手术前后及术后各时期经胸超声心动图资料.结果 院内死亡3例.术毕经食管心脏超声显示二尖瓣无反流69例,轻度反流34例,轻中度反流5例,中重度反流3例,该3例术中改行二尖瓣置换.术后3、12和24个月的生存率分别为96.2%、93.5%和89.7%.射血分数从术前的(46±6)%升至术后的(53±6)%(P＜0.01);左心房内径从术前(58±6)mm下降到术后(46±6)mm(P＜0.01);左心室舒张末内径从(61±8)mm下降到(48±10)mm(P＜0.01).术后二尖瓣反流程度明显下降(P＜0.01),心功能(NYHA分级)有明显改善(P＜0.01).24个月的随访期内,2例冉行二尖瓣置换术.结论 限制性二尖瓣环成形联合CABG治疗缺血性二尖瓣反流的近、中期效果满意,其对左心室重构有着明显逆转作用.

Abstract：

Objective To retrospectively summarize and analyze the short and mid term follow-up outcomes of combined coronary artery bypass grafting ( CABG) and restrictive mitral annuloplasty in curing ischemic cardiomyopathy and ischemic mitral regurgitation (IMR) , and to study its effect on reverse left ventricular remodeling. Methods From January 2000 to June 2008,111 patients of coronary artery disease with morderate to severe IMR underwent combined CABG and restrictive mitral annuloplasty, downsizing by 1-2 ring sizes. There were 81 male and 30 female patients. The age ranged from 36 to 83 years with a mean of (63 ± 18) years. Preoperative transthoracic echocardiography showed minimal to moderate IMR in 7 cases, moderate to severe in 65 cases and severe in 39 cases. The left artrial diameter (LAD) was (58 ±6) mm, left ventricular end-diastolic diameter (LVEDD) was (61 ±8) mm, left ventricular ejection fraction (LVEF) was 46% ±6%. Serial studies were performed to assess the survival rate, the extent of mitral regurgitation (MR), LVEF, the leaflet coaptation height, LAD, LVEDD, New York Heart Association (NYHA) functional class. Results Hospital mortality was 2.7% (3 cases). Each case received an undersized ring. Intraoperative transesophageal echocardiography showed that no regurgitation in 69 cases,minimal in 34 cases, minimal to moderate in 5 cases, moderate to severe in 3 cases which received mitral valve replacement. The 3-, 12- and 24-month survival rate was 96. 2% , 93. 5% and 89. 7% respectively.Mitral regurgitation grade decreased after the operative prodecures (P ＜0. 01). LVEF increased from (46 ± 6) % to (53 ±6) % (24 months follow-up) (F＜0. 01). LAD decreased from (58 ±6) mm to (46 ±6)mm(24 months follow-up) (P ＜0. 01). LVEDD decreased from (61 ±8) mm to (48 ± 10) mm (24 months follow-up) (P ＜ 0. 01 ) . There was no significant decline of LVEDD in 18 cases ( 16. 2% ) whose preoperative mean LVEDD was (69 ±9) mm. NYHA functional class improved after operative procedures ( P ＜ 0. 01) . At 24 months follow-up, 2 cases received valvular replacement Conclusions Combined CABG and restrictive mitral annuloplasty is a feasible and effective treatment for IMR, the short and mid term outcomes are satisfactory, and a significant reduction of LVEDD and an increase of LVEF due to reverse ventricular remodeling were observed.

The outcomes of restrictive mitral annuloplasty and coronary artery bypass grafting for ischemic mitral regurgitation and reverse left ventricular remodeling

Objective To retrospectively summarize and analyze the short and mid term follow-up outcomes of combined coronary artery bypass grafting ( CABG) and restrictive mitral annuloplasty in curing ischemic cardiomyopathy and ischemic mitral regurgitation (IMR) , and to study its effect on reverse left ventricular remodeling. Methods From January 2000 to June 2008,111 patients of coronary artery disease with morderate to severe IMR underwent combined CABG and restrictive mitral annuloplasty, downsizing by 1-2 ring sizes. There were 81 male and 30 female patients. The age ranged from 36 to 83 years with a mean of (63 ± 18) years. Preoperative transthoracic echocardiography showed minimal to moderate IMR in 7 cases, moderate to severe in 65 cases and severe in 39 cases. The left artrial diameter (LAD) was (58 ±6) mm, left ventricular end-diastolic diameter (LVEDD) was (61 ±8) mm, left ventricular ejection fraction (LVEF) was 46% ±6%. Serial studies were performed to assess the survival rate, the extent of mitral regurgitation (MR), LVEF, the leaflet coaptation height, LAD, LVEDD, New York Heart Association (NYHA) functional class. Results Hospital mortality was 2.7% (3 cases). Each case received an undersized ring. Intraoperative transesophageal echocardiography showed that no regurgitation in 69 cases,minimal in 34 cases, minimal to moderate in 5 cases, moderate to severe in 3 cases which received mitral valve replacement. The 3-, 12- and 24-month survival rate was 96. 2% , 93. 5% and 89. 7% respectively.Mitral regurgitation grade decreased after the operative prodecures (P ＜0. 01). LVEF increased from (46 ± 6) % to (53 ±6) % (24 months follow-up) (F＜0. 01). LAD decreased from (58 ±6) mm to (46 ±6)mm(24 months follow-up) (P ＜0. 01). LVEDD decreased from (61 ±8) mm to (48 ± 10) mm (24 months follow-up) (P ＜ 0. 01 ) . There was no significant decline of LVEDD in 18 cases ( 16. 2% ) whose preoperative mean LVEDD was (69 ±9) mm. NYHA functional class improved after operative procedures ( P ＜ 0. 01) . At 24 months follow-up, 2 cases received valvular replacement Conclusions Combined CABG and restrictive mitral annuloplasty is a feasible and effective treatment for IMR, the short and mid term outcomes are satisfactory, and a significant reduction of LVEDD and an increase of LVEF due to reverse ventricular remodeling were observed.