中度缺血性二尖瓣反流外科治疗的近期疗效

Short-term outcome of surgical treatment of moderate ischemic mitral regurgitation

目的评价冠状动脉旁路移植（CABG）手术同期施行二尖瓣修复（MVP）在中度功能性缺血性二尖瓣反流（IMR）患者外科治疗中的早期临床预后。方法回顾性分析2007年6月至2011年9月接受外科治疗的129例冠心病合并中度IMR患者的临床资料，其中57例（44．2％）施行CABG联合MVP手术，72例（55．8％）施行单纯CABG。术后随访患者心功能NYHA分级以评估患者临床状态；超声心动图检测术后左心室舒张末期内径（LVEDD）、左心室收缩末期内径（LVESD）、左心室射血分数（LVEF）以评估患者左心室重构的逆转；记录术后残余二尖瓣反流，以及患者主要的心、脑血管事件。结果两组患者术前临床资料差异无统计学意义（P〉0．05）。患者院内死亡5例（3．9％），CABG组死亡2例（2．8％），联合手术组死亡3例（5．3％）。术后平均随访24个月，晚期死亡9例（CABG组5例，CABG＋MVP组4例），Kaplan-Meier生存分析两组患者累计生存率差异（P=0．645）与主要心、脑血管事件免除率差异（P=0．761）均无统计学意义。联合手术组二尖瓣反流程度明显降低（P〈0．01）。与术前状态相比较，两组左心室重塑指标如LVEDD、LVESD、LVEF均有明显改善（P〈0．05），但组间差异并无统计学意义（P〉0．05）。NYHA心功能分级较术前降低显著（P〈0．001）。结论对于中度IMR患者，MVP虽可有效改善患者的术后二尖瓣反流，但CABG联合MVP手术在左心室重塑的逆转、近期生存及心功能状态等方面并未带来更多的益处。

Objective To evaluate the short-term-outcome of MVP in the treatment of moderate IMR patients with CABG. Methods Data from 129 patients with moderate IMR who underwent surgical treatment in our department from June 2007 to September 2011, 57 patients （44.2%） underwent CABG combined with MVP, and 72 patients （ 55.8% ） underwent CABG. Postoperative follow-up of patients with heart function NYHA grade to evaluate the clinical status of patients, with LYESD, LVEF, LVEDD to evaluate the reverse of left ventrieular remodeling; The postoperative residual mitral regurgitation and major cardiac cerebral vascular events were recorded. Results There was no significant difference between two groups in the preoperative data（P 〉0.05）. The mortality rate was 3.9% （5 cases） , 2 eases（2.8% ） died in CABG group, 3 cases（5. 3 % ） died in the combined surgery group. The average follow-up was 24 months, 9 eases of late death（5 in CABG group, 4 in CABG ＋ MVP group） , the cumulative survival rate（ P = 0. 645 ） and the major cardiovascular events （ P = 0. 761 ） of the two groups were not statistically different. The degree of mitral regurgitation（ P 〈 0.01 ） was significantly decreased in the combined surgery group. Compared with the preoperative state, the two groups of left ventricular remodeling indicators such as LVESD, LVEF, LVEDD were significantly improved （P 〈 0.05 ）, but the difference between two groups was not significant （ P 〉 0.05 ）. NYHA heart function classification was significantly improved （ P 〈 0. 001 ）. Conclusion MVP can effectively improve the re- verse flow of patients with moderate IMR, but CABG combined with MVP can not bring more benefits in the reversal of left ven- trieular remodeling, short-term survival and cardiac function.