腱索折叠与人工腱索矫治二尖瓣前瓣脱垂的比较分析

Repair of anterior leaflet mitral valve prolapse： the comparison between chordal replacement and chordal shortening

目的评价腱索折叠和人工腱索两种成形术治疗二尖瓣前瓣脱垂（ALP）的效果。方法回顾性分析1990年3月至2008年3月接受上述两种成形术治疗的50例ALP患者的临床资料。全组男性29例，女性21例；年龄（42．6±11．3）岁。其中腱索折叠组23例，人工腱索组27例。结果围手术期腱索折叠组病死率13．0％（3／23），高于人工腱索组的3．7％（1／27）（P=0．199）。随访时间为1个月～18年，总随访时间为278人年。两组晚期死亡各3例，5～8年生存率腱索折叠组为70．0％±18．2％，人工腱索组为86．8％±9．2％（X^2=8．17，P=0．046）。再次手术腱索折叠组4例，人工腱索组1例，两次手术间隔时间为（26±17）个月；5年免除再次手术率分别为83．3％±15．2％和100％（X^2=12．06，P=0．007）。多因素回归分析显示，腱索折叠术是ALP成形术晚期心脏事件的独立危险因素。结论人工腱索成形术矫治ALP在远期生存上要优于腱索折叠术。

Objective To compare the relative merits between chordal shortening and artificial chordae to repair the anterior leaflet prolapses （ALP）. Methods The clinic data of 50 cases underwent repair of ALP from March 1990 to March 2008 were analyzed retrospectively. There were 29 male and 21 female patients with a mean age of （42. 6±11.3 ） years old. There were 23 patients in chordal shortening group and 27 patients in artificial chordae group. Results There were 3 operative deaths in chordal shortening group （ 13.0% ） , and 1 death in artificial chordae group （3.7%,P=0.199）. With a mean follow-up of （ 5.8±4. 8 ） years and a total follow-up of 278 patient-years, there were 3 late deaths respectively in each group. According the Kaplan-Meier survival curve, the actuarial survival rate at 5 -8 years was 70. 0%±18.2% for chordal shortening group and 86. 8%±9. 2% for artificial chordae group （X^2=8.17,P=0.046）. There were 5 reoperations, of which g in chordal shortening group and 1 in artificial chordae group. According to the Kaplan-Meier freedom from reoperation curve, the freedom from reoperation at 5 years was 83.3%±15.2% for chordal shortening group and 100% for artificial chordae group （X^2=12.06,P=0.007）. The COX proportional hazard regressions revealed that chordal-shortening technique was the independent risk predictor for the late cardiac event after ALP surgical repairment. Conclusion Artificial chordae techniques has a relative superiority to chordal shortening for repair of mitral valve ALP.