人工腱索植入术后左心室重构变化情况及对二尖瓣反流复发的影响  

Changes of left ventricular remodeling after artificial chordae implantation and its effect on the recurrence of mitral regurgitation

作　　者：姜兆磊[1] 梅举[1] 黄健兵[1] 丁芳宝[1] 汤敏[1] 刘浩[1] 蔡捷 沈赛娥[2] Jiang Zhaolei;Mei Ju;Huang Jianbing;Ding Fangbao;Tang Min;Liu Hao;Cai Jie;Shen Saie(Department of Cardiothoracic Surgery,Xinhua Hospital,School of Medicine,Shanghai Jiaotong University,Shanghai 200092 China;Department of Anesthesiology,Xinhua Hospital,School of Medicine,Shanghai Jiaotong University,Shanghai 200092,China)

机构地区：[1]上海交通大学医学院附属新华医院心胸外科,上海200092 [2]上海交通大学医学院附属新华医院麻醉科,上海200092

出　　处：《中华胸心血管外科杂志》2023年第8期449-453,共5页Chinese Journal of Thoracic and Cardiovascular Surgery

基　　金：上海市科委科研计划项目(22QC1401100);上海交通大学“交大之星”计划医工交叉研究基金(YG2022ZD008)。

摘　　要：目的探讨人工腱索植入术后左心室重构变化情况及对二尖瓣反流复发的影响。方法回顾性分析2010年1月至2019年12月我院应用人工腱索技术修复重度二尖瓣关闭不全(CarpentierⅡI型)141例患者的临床资料。根据随访超声心动图有无中度以上反流分为严重反流组(15例)和无严重反流组(126例)。观察人工腱索植入术后左心室逆重构(left ventricular reverse remodeling,LVRR)对二尖瓣反流复发的影响,分析危险因素。结果全组患者均顺利完成人工腱索二尖瓣成形术。术后早期(术后30天)两组患者即出现明显LVRR,左心室舒张期末内径(LVEDD)和f左心室收缩期末内径(LVESD)较术前明显缩小(P<0.05);术后1年二尖瓣无严重反流组LVRR进一步增加(LVEDD和LVESD进一步缩小,P<0.05),但严重反流组重新出现左心室重构(LVEDD和LVESD较术后早期增大,P<0.05)。术后随访12~132个月,15例患者再次出现中度以上二尖瓣反流。术后早期(术后30天)13例患者出现轻中度或中度反流,其中8例患者在随访时进展为中度以上反流。Cox回归分析显示LVEDD≥65mm(HR=5.573)、术后早期轻中度以上反流(HR=8.801)为人工腱索植入术后二尖瓣反流复发的危险因素。结论术后早期患者即出现明显LVRR,术后1年LVRR程度将进一步增加,但严重反流者将重新出现左心室重构;术后早期LVRR对人工腱索植入术后二尖瓣反流复发有一定影响,而术后1年进一步增强的LVRR对二尖瓣反流复发影响较小。Objective To explore the changes of left ventricular remodeling after artificial chordae implantation and its effect on the recurrence of mitral regurgitation(MR).Methods Clinical data of 141 patients with severe mitral regurgitation(Carpentier type I)repaired by artificial chordae technique in our hospital from January 2010 to December 2019 were retro-spectively analyzed.Patients were divided into significant regurgitation group(15 cases)and non-significant regurgitation group(126 cases)according to the presence or absence of moderate regurgitation by follow-up echocardiography.To observe the effect of left ventricular reverse remodeling(LVRR)on the recurrence of MR after artificial chordae implantation and analyze the risk factors.ResultsAll patients successfully underwent mitral valvuloplasty with artificial chordae.In the early postoper-ative period(30 days after operation),LVRR appeared in both groups(LVEDD and LVESD were significantly smaller than those before operation,P<0.05);LVRR was further enhanced(LVEDD and LVESD were further reduced,P<0.05)in non-significant regurgitation group at 1 year after operation,but left ventricular remodeling reoccurred in significant regurgita-tion group at 1 year after operation(LVEDD and LVESD increased compared with the early postoperative period,P<0.05).After 12-132 months'follow-up,15 patients had more than moderate MR.In the early postoperative period,13 patients had more than mild MR,8 of which evolved to more than moderate MR during fllow-up.Cox regression showed that LVEDD≥65mm(HR=5.573)and more than mild MR in the early postoperative period(HR=8.801)were the risk factors for the recurrence of MR after artificial chordae implantation.Conclusion LVRR appeared in the early postoperative period,and the degree of LVRR further increased at 1 year after operation,but the patients with significant MR would reappear left ventricular remodeling.Early postoperative LVRR had a bad effect on the recurrence of MR after artificial chordae implantation,while further enhanced LV

关 键 词：人工腱索 二尖瓣成形 二尖瓣反流 左心室逆重构 

分 类 号：R654.2[医药卫生—外科学]