改良保留前叶技术在二尖瓣置换术中的应用

Mitral Valve Replacement with Modifi ed Anterior Leafl et Preservation Technique

目的总结改良保留前叶技术在二尖瓣置换术中的临床应用和体会,提高临床治疗效果,降低术后死亡率和并发症发生率。方法纳入2005年5月至2012年12月北京安贞医院采用改良保留二尖瓣前叶的瓣膜置换术128例患者,作为改良组,同期行主动脉瓣置换术14例;其中男49例、女79例,年龄(45.0±12.3)岁。同期纳入行常规二尖瓣置换术的患者128例作为对照组,其中男55例、女73例,年龄(48.0±8.4)岁。两组患者术前情况差异无统计学意义(P>0.05)。结果改良组无围手术期死亡,6例开胸止血,4例出现低心排血量,5例并发肺部感染,1例行气管切开,3例出现肾功能衰竭。对照组早期死亡5例,3例死于左心室后壁破裂,2例死于严重低心排血量。5例开胸止血,12例出现低心排血量,4例并发肺部感染,6例出现肾功能衰竭。术后6个月心脏超声心动图随访结果显示改良组术后左心室射血分数、左心室舒张期末内径、收缩期末内径均较对照组有改善,其中两组左心室射血分数和收缩期末内径差异有统计学意义(P<0.05),两组左心室舒张期末内径差异无统计学意义(P>0.05)。改良组术前、术后射血分数、舒张期末内径、收缩期末内径差异均有统计学意义(P<0.05),对照组术前、术后舒张期末内径差异有统计学意义(P<0.05),射血分数和收缩期末内径差异无统计学意义(P>0.05)。结论改良保留前叶的二尖瓣置换术近期效果良好,方法简便易行,适合各种类型的二尖瓣病变,尤其是退行性病变和感染性心内膜炎。

Objective To summarize clinical outcomes of mitral valve replacement （MVR） with modified anterior leaflet preservation technique,improve therapeutic effects and reduce postoperative mortality and morbidity. MethodsFrom May 2005 to December 2012,128 patients underwent MVR with modified anterior leaflet preservation technique （modified group） in Beijing Anzhen Hospital,among whom 14 patients received concomitant aortic valve replacement. There were 49 male and 79 female patients in the modified group with their age of 45.0±12.3 years. Another 128 patients who underwent routine MVR during the same period were also included in this study as the control group,including 55 maleand 73 female patients with their age of 48.0±8.4 years. There was no statistical difference in preoperative clinical characteristics between the 2 groups （P〉0.05）. Results In the modified group,there was no perioperative death. Postoperatively,6 patients received reexploration for bleeding,4 patients had low cardiac output syndrome,5 patients had pulmonary infection,1 patient received tracheostomy,and 3 patients had acute kidney failure （AKI）. In the control group,5 patients died postoperatively including 3 patients with left ventricular rupture and 2 patients with severe low cardiac output syndrome.Postoperatively,5 patients received reexploration for bleeding,12 patients had low cardiac output syndrome,4 patients had pulmonary infection,and 6 patients had AKI. Echocardiography at 6th month during follow-up showed that left ventricular ejection fraction （LVEF）,left ventricular end-diastolic dimension （LVEDD） and left ventricular end-systolic dimension （LVESD） of modified group patients were improved compared with control group patients. There was statistical differencein LVEF and LVESD between the 2 groups （P〈0.05）. There was no statistical difference in LVEDD between the 2 groups（P〉0.05）. LVEF,LVEDD and LVESD of modified group patients during follow-up were statistically different frompreoperative values （P〈0.05）. LVEDD of control group patients during follow-up was statistically different from preoperative LVEDD （P〈0.05）. LVEF and LVESD of control group patients during follow-up was not statistically different from preoperative values （P〉0.05）. Conclusion MVR with modified anterior leaflet preservation technique is simple to perform with satisfactory short-term results. This technique is suitable for various types of mitral valve diseases especiallydegenerative mitral valve disease and infective endocarditis.