二尖瓣直视成形术的疗效评价

Estimation of the effect of mitral valve correction

三十余年中，阜外医院共行二尖瓣直视成形术４８８例。住院死亡率１１．２７％，１９８０年以后为７％。平均随访１２．３３±８．８３年，远期死亡率１．９９％人年，再手术率０．３７％人年，栓塞率０．５％人年。

AbstractFrom September 1958 to December 1992 , 488 pa-tients underwent mitral valve repair in Fuwai Hospital.Patients ages ranged from 49 days to 60. 5 years (meanage 29. 02±9. 97 years). The cause of mitral valve dis-ease was rheumatic in 415 patients(85. 04%). 391 pa-tients (80. 12%)had isolated mitral valve disease and97 patients(19. 88%)had associated with aortic or tri-cuspid valve disease,or both.Tbere were 167 patients(34. 22%)with pure mitral stenosis, 106 patients(21. 72%)with pure mitral regurgitation and 215 pa-tients ( 44. 06%)with both. 64. 96% of the patientswere in New York Heart Association(NYHA)Ⅲ andⅣ before the operation. There were 433 patients(88. 73%)with isolated mitral valve repair and 55 pa-tients(11. 27%)with mitral valve repair associatedwith other valve repair. The hospital mortality rate was 11. 27%(7. 00%after 1980).7. 39%of the patients were in NYHA Ⅲand Ⅳ afteroperation(P<0.01 ).Follow-up was92. 38% complete and totaled 4824. 12 patient-years.The mean follow-up time was 12.3±8. 83 years. The5-year,10-year and 20-year survival rates were94.92%,89.70%and 70. 19%, respectively. The rateof reoperation was 4. 16%(0.37%/pt-yr)and the oneof thromboemboli was 5. 54%(0. 498%/pt-yr).Thefollow-up mortality and reoperation rate of rheumaticmitral valve disease were significently higher than theother causes(P< 0. 01 ). In hospital and follow-up re-sults of the pure MI were better than the MS and MSI(P<0.01).The better results were obtained in mitralannuloplasty with prosthetic valve ring