冠状动脉旁路移植术联合二尖瓣成形术与经皮冠状动脉介入治疗对缺血性二尖瓣关闭不全的疗效分析

目的 分析冠状动脉旁路移植术（coronary artery bypass graft，CABG）+二尖瓣成形术（mitral valvuloplasty，MVP）与仅行经皮冠状动脉介入治疗（percutaneous coronary intervention，PCI）对重度慢性缺血性二尖瓣关闭不全（chronic ischemic mitral incompetence，CIMI）的疗效。方法 选取2018年1月至2020年1月于郑州大学第一附属医院诊治的重度CIMI患者115例，根据患者手术方式不同将其分为PCI组（n=59）和CABG+MVP组（n=56）。收集患者的性别、年龄、合并疾病等临床基本特征及术前超声参数，比较两种手术对术后二尖瓣反流的疗效。结果 CABG+MVP组患者的年龄显著小于PCI组，左室射血分数显著大于PCI组（P<0.05）。PCI组患者术后二尖瓣反流无改善或复发率是CABG+MVP组的6.01倍（OR=6.01，95%CI：2.450～15.132，P<0.05）。CABG+MVP组患者术后二尖瓣反流的好转程度优于PCI组（P<0.05）。结论 针对重度CIMI，虽然外科手术治疗伴随着术后高死亡率，但行CABG+MVP的患者术后二尖瓣反流情况优于仅行PCI的患者。

Analysis of the efficacy of coronary artery bypass graft combined with mitral valvuloplasty and percutaneous coronary intervention in ischemic mitral valve incompetence

Objective To analyze the effects of coronary artery bypass graft (CABG) + mitral valvuloplasty (MVP) and percutaneous coronary intervention (PCI) alone on severe chronic ischemic mitral incompetence (CIMI). Methods A total of 115 patients with severe CIMI treated in the First Affiliated Hospital of Zhengzhou University from January 2018 to January 2020 were selected and divided into PCI group (n=59) and CABG+MVP group (n=56) according to different surgical methods. The clinical characteristics of the patients, such as gender, age, complicated diseases, and preoperative ultrasound parameters were collected, and compare the effect of two kinds of operation on mitral regurgitation after operation. Results The age of patients in CABG+MVP group was significantly lower than that in PCI group, and left ventricular ejection fraction was significantly higher than that in PCI group (P<0.05). The rate of no improvement or recurrence of mitral regurgitation in PCI group was 6.01 times that in CABG+MVP group (OR=6.01, 95%CI: 2.450-15.132, P<0.05). The improvement of mitral regurgitation in CABG+MVP group was better than that in PCI group (P<0.05). Conclusion For severe CIMI, mitral regurgitation in patients undergoing CABG + MVP is better than that in patients undergoing PCI alone, although surgical treatment is associated with high mortality after operation for severe CIMI.