冠状动脉旁路移植术同期二尖瓣成形治疗缺血性二尖瓣关闭不全疗效观察  

Coronary artery bypass grafting combined with mitral valvoloplasty for the treatment of ischemic mitral regurgitation

作　　者：朱勇锋[1] 张向立[1] 浮志坤[1] 杜鹏 杨恒[1] 张曙光 ZHU Yong-feng, ZHANG Xiang-li, FU Zhi-kun, et al.(Department of Cardiovascular Surgery, Zhengzhou Cardiovascular Hospital, Zhengzhou No.7 People＇s Hospital, Zhengzhou 450000, Chin)

机构地区：[1]郑州市第七人民医院郑州市心血管病医院心外科

出　　处：《中国心血管病研究》2018年第3期254-258,共5页Chinese Journal of Cardiovascular Research

摘　　要：目的观察缺血性二尖瓣关闭不全行二尖瓣成形同期冠状动脉旁路移植术患者早期预后，分析其危险因素。方法回顾性研究2012年1月至2015年10月因缺血性二尖瓣关闭不全于我院行二尖瓣成形同期冠状动脉旁路移植术的患者。入组患者33例，二尖瓣成形环应用于所有患者，所有患者均采用二尖瓣硬质成形环。入组患者平均年龄为（58．3±7．7）岁，51．5％术前心功能分级〉Ⅱ级，术前左心室舒张末径为（58．0±4．7）mm，射血分数为（52．3±11．4）％。终点事件为术后死亡、二尖瓣再次手术、术后出现二尖瓣中量以上返流需手术干预、心力衰竭。结果对所有患者术后随访资料进行分析，平均随访时间为（20．3±8．5）个月。单因素分析显示，二尖瓣瓣环扩张、心功能大于Ⅱ级及室壁瘤是与终点事件发生相关的危险因素。多因素分析显示，瓣环扩张、心房颤动和主动脉阻断时间是影响早期预后的独立危险因素，术前瓣环扩张的患者较无瓣环扩张者有着更高的终点事件发生率（HR=5．64，95％CI 1．20±28．05，P〈0．05）。结论对于因缺血性二尖瓣关闭不全行二尖瓣成形术合并冠状动脉旁路移植术的患者，二尖瓣瓣环扩张、心房颤动和较长的主动脉阻断时间是影响其早期预后的独立危险因素，术前瓣环扩张的患者较无瓣环扩张者终点事件发生率更高。Objective The aim of this study was to identify the predictors of early prognoses and survivals in patients with ischemic mitral regurgitation（IMR） who had undergone mitral valvuloplasty（MVP） combined with revascularization. Methods From January 2012 to December 2015, 33 patients with IMR who had undergone MVP combined with coronary artery bypass graft（CABG） in our institution were enrolled. Mitral valve annuloplasty rings were used in all patients. Patients＇ mean age was （58.3±7.7）years, New York Heart Association（NYHA） class III or IV was 51.5%, preoperative left ventricular end-diastolic diameter（LVEDD） was （58.0±4.7）mm and ejection fraction（EF） was （52.3%±11.4）%. The study endpoints were postoperative death, reoperation, recurrence of moderate or severe mitral regurgitation and heart failure. Results Follow-up data were obtained in all patients. Mean follow-up was （20.3±8.5）months. Preoperative characteristics were comparable between the two groups. Only mitral annular dilatation （AD） was significantly different between the groups （57.9% vs. 30.3%, P=0.02）. AD, NYHA class III or IV, ventricular aneurysm （VA） were powerful risk factors of endpoint events on univariate analysis. After adjustments, Cox proportional-hazards regression analysis showed that AD, atrial fibrillation, aortic cross clamp time were the risk factors of early prognoses. Moreover, patients with annular dilatation showed significantly higher rate of endpoint events than those without annular dilatation （HR=5.64, 95%CI 1.20-28.05, P〈 0.05）. Conclusion In patients with IMR, annular dilatation, atrial fibrillation, and long aortic cross clamp time were independent risk factors of early prognoses after MVP combined with CABG. Patients with annular dilatation showed higher rate of endpoint events than those without annular dilatation.

关 键 词：二尖瓣成形术 危险因素 缺血性二尖瓣关闭不全 再血管化 

分 类 号：R654.2[医药卫生—外科学]