自体瓣膜心内膜炎二尖瓣成形与二尖瓣置换远期疗效的病例对照研究

Long-term outcomes following mitral valvuloplasty versus replacement for native valve endocarditis: A case control study

目的探索自体瓣膜心内膜炎(NVE)患者二尖瓣成形(MVP)和二尖瓣置换(MVR)的远期疗效差异。方法 1993年11月至2016年8月我院连续101例NVE患者行二尖瓣手术,其中MVP 52例,MVR 49例。男69例、女32例,平均年龄(38.1±14.9)岁。平均随访(99.4±75.8)个月。结果两组患者体外循环时间、主动脉阻断时间、住院死亡、术后机械通气时间、ICU滞留时间以及术后住院时间差异无统计学意义。术后1年、5年、10年、20年MVP组的生存率分别为100.0%、97.6%、97.6%、97.6%,MVR组分别为93.5%、84.3%、84.3%、66.2%(P=0.018)。术后1年、5年、10年、20年MVP组无卒中事件发生,MVR组无卒中事件生存率分别为100.0%、93.9%、89.4%、70.2%,两组差异有统计学意义(P=0.023)。两组感染复发、瓣周漏及再手术发生率差异无统计学意义。术后1年、5年、10年、20年MVP组无复合终点事件生存率分别为100.0%、97.6%、92.9%、92.9%,MVR组无复合终点事件生存率分别为91.3%、79.6%、75.8%、51.0%,MVP组不良事件明显少于MVR组,且差异有统计学意义(P=0.006)。结论对于NVE二尖瓣病变患者MVP比MVR更有优势,应积极推广MVP技术在NVE中的应用。

Objective To compare long-term outcomes following mitral valvuloplasty （MVP） and mitral valve replacement （MVR） for native valve endocarditis （NVE）. Methods Between November 1993 and August 2016, consecutive 101 patients with NVE underwent mitral surgery in our department, MVP for 52 patients and MVR for 49 patients. There were 69 males and 32 females at age of 38.1±14.9 years. The mean follow-up was 99.4±75.8 months. Results There was no statistical difference in cardiopulmonary bypass time, aortic cross-clamp time, in-hospital mortality, duration of mechanical ventilation, ICU stay or hospital stay after surgery between the two groups. Survival rate at 1, 5, 10, 20 years after surgery was 100.0%, 97.6%, 97.6%, 97.6% for MVP, and 93.5%, 84.3%, 84.3%, 66.2% for MVR with a statistical difference between the two groups （P=0.018）. There was no stroke in the patients with MVP during follow-up periods. However, stroke-free survival rate at 1, 5, 10, 20 years after surgery was 100.0%, 93.9%, 89.4%, 70.2% for MVR patients with a statistical difference between the two groups （P=0.023）. There was no statistical difference in recurrence of infection, perivalvular leakage and reoperation between the two groups. Composite endpoint-free survival rate at 1, 5, 10, 20 years after surgery was 100.0%, 97.6%, 92.9%, 92.9% for MVP, and 91.3%, 79.6%, 75.8%, 51.0% for MVR with a statistical difference （P=0.006）. Conclusion MVP is associated with better outcomes than MVR in the patients with NVE; generalizing MVP technique in the patients with NVE is needed.