缺血性二尖瓣关闭不全的外科治疗

Surgical treatment for ischemic mitral valve regurgitation

目的 分析总结单中心外科治疗缺血性二尖瓣关闭不全的临床经验.方法 回顾性分析279例缺血性二尖瓣关闭不全患者的临床资料,平均年龄（59.2±7.4）岁;心功能分级Ⅱ级141例、Ⅲ级117例、Ⅳ级21例;左室舒末内径57～91 nn,左室射血分数20％～59％;二尖瓣返流程度：中度156例、中-重度75例、重度48例;冠脉造影结果三支病变240例,两支病变30例,单支病变9例.结果 二尖瓣成形术224例,术后即刻经食管超声心动图（TEE）示无返流152例,微量返流43例,微量-轻度21例,轻度8例.二尖瓣置换术55例,IABP辅助37例.冠状动脉旁路移植远端吻合口（3.6±0.5）个.手术死亡13例,死亡率4.7％（13/279）.出院时左室舒末内径46～86 mm,左室射血分数20％～62％.二尖瓣无返流232例,微量26例,轻度12例,轻-中度7例,中度2例.结论 外科治疗冠心病合并缺血性二尖瓣关闭不全可获得满意的治疗效果,尤其是射血分数降低、左心增大、心力衰竭的患者,获益更大.

Objective The purpose of this paper is to review the single center＇s surgical experience in treatment of ischemic mitral regurgitation.Methods Retrospective analysis of 279 patients with ischemic mitral regurgitation.The mean age was （59.2±7.4）years.Heart function class 1Ⅱ 141 cases,class Ⅲ 117 cases,class Ⅳ 21 cases.Left ventricular end diastolic diameter 57-91 mm,left ventricular ejection fraction 20%-59%.The severity of mitral regurgitation：moderate in 156 cases,moderate to sever in 75 cases,48 cases were severe.The results of coronary angiography：three-vessel lesions in 240 cases,30 cases with two vessel lesions,9 patients with single vessel disease.Results Mitral valve repair in 224 cases,and postoperatively immediate TEE examination revealed no regurgitation in 152 cases,trace in 43 cases,21 cases of trace to mild and 8 cases of mild.Mitral valve replacement was performed in 55 cases.IABP assisted in 37 cases.The mean number of distal anastomosis was 3.6±0.5.13 cases died and the mortality rate was 4.7%（13/279）.The left ventricular end diastolic diameter was 46-86 mm,and left ventricular ejection fraction 20%-62% at discharge.232 cases without regurgitation,trace in 26 cases,12 cases of mild,mild to moderate in 7 cases and moderate in 2 cases.Conclusion Surgical treatment for ischemic mitral regurgitation could obtain satisfactory outcomes with greater benefit especially for the patients with reduced ejection fraction,left heart enlargement,or heart failure.