经皮二尖瓣球囊扩张术12年临床随访研究

12 years follow-up result of percutaneous balloon miral valvuloplasty

目的 对经皮二尖瓣球囊扩张术 (PBMV)后病人 12年随访资料作了回顾性分析 ,以确定再狭窄率、远期疗效及其影响因素。方法 对 1990年 5月至 2 0 0 2年 5月随访资料完整的 3 44例患者进行了回顾性研究 ,其中男性86例、女性 2 5 8例、年龄 40 .2± 9.6(15 -70 )岁。随访时间 1年 -12年 ,平均 3 .6± 2 .5年。对影响远期疗效的因素 ,用cox风险模型作了分析。结果 术后 1-12年随访表明 ,3 44例一年无事件生存率 10 0 % ,再狭窄 9例 (2 .5 % )、2 86例 3年无事件生存率 97% ,再狭窄 3 9例 (13 .6% )、2 2 1例 5年无事件生存率 91%、再狭窄 60例 (2 7.1% )、81例 8年无事件生存率 80 %、再狭窄 3 2例 (3 9.5 % )、42例 10年无事件生存率 69%、再狭窄 2 0例 (4 7.6% )、16例 12年无事件生存率 63 %、再狭窄 9例 (5 6.3 % )。李氏记分 10分组的无事件生存率优于记分 >10组。结论 多数PBMV病人远期疗效良好 ,李氏记分≤ 10分 ,窦性心律、术前心功能较好、术后瓣口面积较大以及双侧交界裂开的患者PBMV远期疗效最佳。

Objective:This study reports the clinical 12 years follow-up results of 344 patients who underwent percutaneous balloon mitrail valvuloplasty(PBMV),in order to identify the long-term outcome,the incidence of restenosis,and the determining factors of restenosis.Methods:Four hundred and sixty five patients with mitral stenosis(MS)underwent PBMV from May 1990to May 2002.Among the 465 patients,a retrospective study of 344 cases with complete data were presented in this article. This series included 258 females and 86 males.The mean age was 40.2±9.6(15-72 years old).They were followed-up after PBMV. The data were analyzed with SAS software.Results:Follow-up of 1-12 years(median 3.6±2.5years)showed that the one-years event-free survival rate was 100% with restenosis 9 cases(2.5%) in 344 cases,the three-years event-free survival rate was 97% with restenosis 39 cases(13.6%)in 286 cases,the five-years event-free survival rate was 91% with restenosis 60 cases (27.1%) in 221 cases, the eight-years event-free survival rate was 80% with restenosis 32 cases(39.5%) in 81cases,and the ten-years event-free survival rate was 69%with restenosis 20 cases (47.6%) in 42 cases,and the twelve-years event-free survival rate was 63%with restenosis 9 cases(56.3%) in 16 cases.The event-free survival rate was greater in patients with LI' echocardiographic score≤10?Conclusion:PBMV can produce good clinical Long-term outcome in most patients especially those with LI' echocardiographic score≤10, bi-commissural splitting,sinus rhythm,large mitral valve area after PBMV,without poor cardiac function may have the best long-term result.