三种不同左房室瓣修复策略治疗肥厚型梗阻性心肌病合并左房室瓣关闭不全的远期疗效对比研究  

Comparison of Long-term Efficacy of Three Different Strategies of Mitral Valve Repair in the Treatmnet of Hypertrophic Obstructive Cardiomyopathy Complicated with Mitral Insufficiency

作　　者：庞帅 Muradyan Musheg Muradyan Regina 陈宗皓 桑鹏超 谷腾飞 李佳慧 袁金达 PANG Shuai;Muradyan Musheg;Muradyan Regina;CHEN Zonghao;SANG Pengchao;GU Tengfei;LI Jiahui;YUAN Jinda(Center for Cardiovascular Surgery,the People Hospital of Huaiyin,Jinan,Jinan 250021,China;Center for Cardiovascular Surgery,Bakulev,Russia,Moscow 119049,Russia;Cardiac Surgery,Beijing Anzhen Hospital,Capital Medical University,Beijing 100029,China;Department of Cardiothoracic and Vascular Surgery,German Heart Center Berlin(DHZB),Berlin 1335,German;Cardiac Surgery,Fuwai Central China Cardiovascular Hospital,Zhengzhou 451464,China;Cardiothoracic and Breast Surgery,Jiangmen Wuyi Hospital of TCM,Jiangmen 529000,China)

机构地区：[1]山东省济南市槐荫人民医院心脏中心,250021 [2]俄罗斯巴库列夫心血管外科研究中心,俄罗斯莫斯科119049 [3]首都医科大学附属北京安贞医院心脏外科,北京市100029 [4]德国柏林心脏中心心胸血管外科,1335 [5]阜外华中心血管病医院心脏外科,河南省郑州市451464 [6]广东省江门市五邑中医院心胸乳腺外科,529000

出　　处：《实用心脑肺血管病杂志》2020年第10期121-126,共6页Practical Journal of Cardiac Cerebral Pneumal and Vascular Disease

摘　　要：背景肥厚型梗阻性心肌病(HOCM)常合并左房室瓣关闭不全(MI),左房室瓣修复比左房室瓣置换疗效更好,并发症更少。常用的左房室瓣修复技术中,“Sliding”左房室瓣成形术联合左房室瓣成形环植入术效果确切,但操作复杂;“Edge-to-Edge”左房室瓣成形术操作简单,但疗效尚不确定。目的对比三种不同左房室瓣修复策略治疗HOCM合并MI的远期疗效。方法回顾性选取2005—2012年在俄罗斯巴库列夫心血管外科研究中心进行心脏手术的HOCM合并MI患者58例为研究对象,根据手术方式,将其分为Morrow组(行单纯Morrow手术,24例)、Morrow-E组(行Morrow手术联合“Edge-to-Edge”左房室瓣成形术,18例)、Morrow-S组(行Morrow手术联合“Sliding”左房室瓣成形术及左房室瓣成形环植入术,16例)。统计患者围术期指标〔包括术中永久性起搏器植入情况、体外循环时间、主动脉阻断时间,术后早期(术后住院期间)左心室流出道最大压差、左房室瓣反流程度、室间隔厚度、左心室舒张末期内径、左心房直径、左心室射血分数;术后使用呼吸机时间、入住ICU时间、住院天数,围术期死亡情况〕、随访指标{包括随访时间、主要疗效指标(术后1、2、3年左心室流出道最大压差、左房室瓣反流程度、左房室瓣跨瓣压差)、安全性指标〔术后早期与术后远期(术后3年)的死亡情况〕}。结果Morrow-E组、Morrow-S组术中体外循环时间、术中主动脉阻断时间长于Morrow组,术后早期左心室流出道最大压差、术后早期左房室瓣反流程度低于Morrow组,术后早期左心房直径小于Morrow组(P<0.05);Morrow-S组术中体外循环时间、术中主动脉阻断时间长于Morrow-E组(P<0.05)。三组围术期均无死亡患者。三组随访时间比较,差异无统计学意义(P>0.05)。Morrow组、Morrow-E组、Morrow-S组完成1年随访的患者分别有24、18、16例,完成2年随访的患者分别有24、18、16Background Hypertrophic obstructive cardiomyopathy(HOCM)is often associated with mitral insufficiency(MI).Mitral valve repair is better than mitral valve replacement and has fewer complications.Among the commonly used mitral valve repair techniques,"Sliding"mitral valvuloplasty combined with mitral valvuloplasty ring implantation is effective,but the operation is complicated;"Edge-to-Edge"mitral valvuloplasty is simple to operate,but the efficacy is uncertain.Objective To compare the long-term efficacy of three different strategies of mitral valve repair in the treatmnet of HOCM complicated with MI.Methods A total of 58 HOCM patients complicated with MI who underwent cardiac surgery in Center for Cardiovascular Surgery,Bakulev,Russia from 2005 to 2012 were selected as the research objects.According to the surgical methods,the patients were divided into Morrow group(24 cases underwent simple Morrow operation),Morrow-E group(18 cases underwent Morrow operation combined with"Edge-to-Edge"mitral valvuloplasty),and Morrow-S group(16 cases underwent Morrow operation combined with"Sliding"mitral valvuloplasty and mitral annuloplasty ring implantation).The perioperative indexes〔including permanent pacemaker implantation,cardiopulmonary bypass time and aortic crossclamping time during the operation,left ventricular outflow tract maximum pressure gradient,degree of mitral regurgitation,interventricular septal thickness,left ventricular end diastolic diameter,left atrial diameter and left ventricular ejection fraction in the early postoperative period(postoperative hospitalization),time of ventilator use,ICU stay and hospital stay after operation,perioperative mortality〕,follow-up indicators{including follow-up time,main efficacy indicators(left ventricular outflow tract maximum pressure difference,degree of mitral regurgitation and mitral pressure of gradient at 1,2 and 3 years after operation),safety indexes〔early and long-term(3 years after operation)mortality〕}.Results In Morrow-E group and Morrow-S group,cardio

关 键 词：心肌病 肥厚性 左房室瓣闭锁不全 Morrow手术 “Edge-to-Edge”左房室瓣成形术 “Sliding”左房室瓣成形术 左房室瓣成形环植入术 疗效比较研究 

分 类 号：R542.2[医药卫生—心血管疾病] R542.51[医药卫生—内科学]