二尖瓣成形术治疗中重度黏液样退行性二尖瓣关闭不全远期疗效的影响因素  

Influence factors of long-term outcomes of mitral valve repair for moderate and severe mitral regurgitation due to myxomatous degeneration

作　　者：薛清[1] 韩林[1] 张冠鑫[1] 陆方林[1] 纪广玉[1] 唐昊[1] 郝家骅[1] 徐志云[1] 

机构地区：[1]上海市第二军医大学附属长海医院胸心外科,200433

出　　处：《中华胸心血管外科杂志》2011年第12期724-726,共3页Chinese Journal of Thoracic and Cardiovascular Surgery

摘　　要：目的探讨并总结二尖瓣成形术治疗中、重度黏液样退行性二尖瓣关闭不全远期疗效的影响因素。方法分析1993年1月至2008年1月261例因中、重度黏液样退行性二尖瓣关闭不全行二尖瓣成形术的患者临床资料和随访资料。结果围术期死亡7例，生存254例，生存患者二尖瓣成形效果良好。230例随访≥36个月，平均（77．3±30．3）个月，随访率90．6％；24例失访。多因素Coxre—gression分析显示，年龄≥60岁、左心室射血分数〈0．50、同期行冠状动脉旁路移植术是术后远期死亡的独立危险因素；左心室射血分数〈0．50、心功能（NYHA）Ⅲ-Ⅳ级、前瓣叶脱垂是术后远期二尖瓣再次中、重度反流的独立危险因素，成形环或塑形带成形是术后远期二尖瓣再次中、重度反流的保护因素。结论年龄≥60岁、左心室射血分数〈0．50、同期行冠状动脉旁路移植术、心功能分级Ⅲ-Ⅳ级、前瓣叶脱垂、成形环或塑形带成形等因素与中、重度黏液样退行性二尖瓣关闭不全患者二尖瓣成形术后远期不良事件密切相关。Objective To explore and conclude the influence factors of long-term outcomes of mitral valve repair for moderate and severe mitral regurgitation due to myxomatous degeneration. Methods To review the in-patient data and followup outcomes of 261 patients after mitral valve repair for moderate and severe mitral regurgitation due to myxomatous degeneration from Jan 1993 to Jan 2008 in Changhai Hospital of Second Military Medical University. Results There were 7 perioperatire deaths and 254 survivors who obtained satisfatctory perioperative outcomes. During the follow-up, 24 patients were lost and 230 patients were followed up from 36 months to 174 months （77.3 ± 30.3 ） months and follow-up rate was 90.6%. Multivariate Cox regression shows age ≥ 60 years old, left ventricular ejection fraction 〈 0. 50, undergoing combined coronary artery bypass grafting were the independent risk factors for long-term death afier operations and left ventricular ejection fraction 〈 0. 50, New York Heart Association functional classifiealion Ⅲ - Ⅳ, anterior leaflet prolapse were the independent risk factors for long-term recurrent moderate or severe mitral regurgitation after operations and prosthetic ring or band annulopasty was a pro- tective factor. Conclusion The age ≥60 years old, left ventricular ejection fraction 〈 0.50, undergoing combined coronary artery bypass grafting, New York Heart Association functional classification Ⅲ - Ⅳ, anterior leaflet prolapse, and prosthetic ring or band annulopasty were closely related with long-term adverse events after operations.

关 键 词：二尖瓣关闭锁不全 二尖瓣成形术 随访研究 

分 类 号：R654.2[医药卫生—外科学]