老年主动脉瓣置换术患者合并二尖瓣关闭不全的外科处理策略

Elderly to present the art of the merger the mitral valve is closed to the surgical treatment strategies LIU Wei Henan shangqiu 1st

目的合并二尖瓣返流（MR）对老年（〉65岁）单纯主动脉瓣置换（AVR）患者的影响目前尚不十分清楚。本文主要探讨术前合并二尖瓣中等量返流的老年单纯主动脉瓣置换患者的远期生存及心脏功能改善情况。方法回顾性分析2005—2009年间接受单纯主动脉瓣置换的45例老年患者，其二尖瓣返流情况由术前心脏彩超鉴定，所有病例分为两组，Ⅰ组：二尖瓣轻度返流或无返流组（n=23），Ⅱ组：二尖瓣中度返流组（n=22），术后随访60个月，随访96％完成，远期生存及心脏功能改善情况由术后复查及问卷方式确定。结果Ⅱ组与Ⅰ组比较，术前心肌梗死及充血性心力衰竭的发生率更高，而术后1年、3年、5年的生存率均较低；且术后心功能Ⅱ级（纽约心脏病学会分级NYHA）以上的患者明显少于Ⅰ组病例．问卷调查患者生存质量Ⅱ组低于Ⅰ组。结论在单纯置换主动脉瓣的老年患者中，二尖瓣中度狭窄是影响患者长期预后的独立危险因素，因此，老年主动脉瓣置换患者合并中度二尖瓣关闭不全应考虑置换双瓣。

Objective The impact ofmitral regurgitation （MR） on elderly patients （〉65years） undergoing isolated aortic rcalve replacement （AVR） is not clearly defined. This study investigates the long-term effects of preoperative, moderate MR on survival and functional outcome in elderly AVR patients. Methods A retrospective review identified 45 consecutive elderly patients underwent isolated AVR from 2005 to 2009. The pathologic etiology of MR was determined on preoperative echocardiogram, and patients were stratified into no/mild MR （Group Ⅰ; n=23） versus moderate MR （Group Ⅱ; n=22） . Follow-up was 96% complete. Functional outcome was evaluated using the Short Form-12 questionnaire. Results Groups Ⅰ and Ⅱ differed in incidence of previous myocardial infarction, hypedipidemia, and congestive heart failure. Actuarial survival at 1, 3, and 5 years for Group Ⅰ was higher than Group Ⅱ （P〈0.04） .Conclusions Moderate MR is an independent risk factor impacting long-term survival in elderly patients undergoing AVR. Therefore, patients with intrinsic mitral valve disease should be considered for concomitant MV surgery.