瓣叶切除与人工腱索治疗单纯二尖瓣后叶脱垂的病例对照研究  

Artificial chordae versus leaflet resection for isolated posterior mitral valve prolapse: a propensity score matched study

作　　者：仲肇基 岳子祺 赵振华 杨腾蛟 朱家德 宋武 刘盛 ZHONG Zhao-ji;YUE Zi-qi;ZHAO Zhen-hua;YANG Teng-jiao;ZHU Jia-de;SONG Wu;LIU Sheng(Department of Cardiovascular Surgery, Fuwai Hospital, Chinese Academy of Medical Science, Beijing 100037,China)

机构地区：[1]中国医学科学院阜外医院心外科,北京市100037

出　　处：《中国心血管病研究》2019年第7期651-655,共5页Chinese Journal of Cardiovascular Research

基　　金：首都临床特色应用研究与推广(Z151100004015107);北京协和医学院“协和青年基金”(3332015105).

摘　　要：目的比较单纯二尖瓣后叶脱垂应用瓣叶切除或人工腱索技术行二尖瓣成形术的手术效果.方法 2010年12月至2013年12月,384例患者病因单纯二尖瓣后叶脱垂导致的二尖瓣反流于我科行二尖瓣成形术,其中单纯人工腱索修复者33例(8.6%)、单纯瓣叶切除者258例(67.2%).应用倾向评分匹配进行配对,分为人工腱索组(32例)与瓣叶切除组(32例),并进行比较.回顾性分析两组围手术期情况及术后随访结果.结果倾向评分匹配后人工腱索组和瓣叶切除组的各项术前指标未见统计学差异.两组均顺利完成手术,无围手术期死亡.两组体外循环时间、主动脉阻断时间比较差异均有统计学意义(P=0.009、0.013).人工腱索组使用较大二尖瓣成形环更多(P=0.019).两组出院前左心室射血分数(left ventricular ejection fraction,LVEF)、舒张期峰值二尖瓣跨瓣峰值压差(transmitral gradient,TMG)均未见统计学差异.平均随访(31.8±11.9)个月,两组患者生存、再次手术、≥中度二尖瓣反流、舒张期二尖瓣跨瓣峰值压差、再次手术均未见统计学差异,但人工腱索组LVEF为(66.0±4.1)%,瓣叶切除组LVEF为(61.5±5.9)%,两组间差异有统计学意义(P=0.007).结论人工腱索技术和瓣叶切除技术都可以有效地修复二尖瓣后叶脱垂.人工腱索技术与瓣叶切除技术相比更有利于术后左心室功能,但两种技术在术后生存及二尖瓣反流情况上并无差异.Objective To compare outcomes of artificial chordae versus leaflet resection techniques for repair of isolated posterior mitral leaflet prolapse. Methods From Dec. 2010 to Dec. 2013, a total of 384 mitral valve repairs for isolated posterior leaflet were performed at our hospital. In these patients, 33 cases underwent isolated artificial chordae replacement and 258 cases underwent isolated leaflet resection. The propensity score was used to create matched artificial chordae (n=32) and leaflet resection (n=32) cohorts. Results There were no significant differences between two groups in the preoperative profiles after propensity score matching. There was no peri-operative mortality. The cardiopulmonary bypass time and cross-clamp time was significantly different between the 2 groups (P=0.009,0.013, respectively). More large-size annuloplasty ring were used( P=0.019) in the artificial chordae group, but there was no significant in peak transmitral gradient (TMG). There was no significant difference in mortality, re-operation or recurrent mitral regurgitation during follow-up of (31.8±11.9) months. At the last echocardiography, the peak TMG was similar while the left ventricular ejection fraction (LVEF) was significantly different (P=0.007) between the 2 groups. Conclusion Both artificial chordae and leaflet resection techniques showed demonstrated good midterm results for repair of isolated posterior mitral leaflet prolapse. Although in the artificial chordae technique result in better LVEF.

关 键 词：二尖瓣反流 后叶脱垂 二尖瓣成形术 人工腱索 瓣叶切除 

分 类 号：R654.2[医药卫生—外科学]