二尖瓣成形和置换术治疗室壁瘤合并缺血性二尖瓣返流的对比研究

Comparison between mitral valvuloplasy and mitral valve replacement in treatment of ventricular aneurysm complicated by ischemic mitral regurgitation

目的比较二尖瓣成形术或二尖瓣置换术治疗合并室壁瘤的缺血性二尖瓣返流的围手术期及远期疗效。方法纳入2009年7月~2015年12月于中国医学科学院阜外医院因缺血性二尖瓣返流合并室壁瘤患者行二尖瓣手术者49例。按手术方式分为二尖瓣置换组9例,二尖瓣成形组40例。对上述病例的资料进行回顾性分析,并随访(3.1±2.0)年。结果两组围手术期死亡无统计学差异(P=0.569)。两组出院前二尖瓣返流情况、左室射血分数(LVEF)、左室舒张末径(LVEDD)均较术前显著改善。二尖瓣成形组LVEF高于置换组(P=0.016)。随访期死亡3例。成形组远期二尖瓣返流高于置换组(P=0.020)。末次随访时,两组LVEF、LVEDD均无统计学差异(P=0.981、0.596)。结论在合并室壁瘤的缺血性二尖瓣返流患者中,二尖瓣置换术与成形术手术风险相似。二尖瓣成形存在远期返流复发的风险,但远期生存及心功能无显著差异。

Objective To compare the perioperative and long-term curative effect between mitral valvuloplasy(MVP)and mitral valve replacement(MVR)in treatment of ischemic mitral regurgitation(IMR)complicated byventricular aneurysm.Methods The patients(n=49)undergone mitral valve operation were chosen from the FuwaiHospital of Chinese Academy of Medical Sciences and Peking Union Medical College from July2009to Dec.2015.All patients were divided,according to operation methods,into MVR group(n=9)and MVP group(n=40).The datafrom all patients were retrospectively analyzed and the patients were followed up for(3.1±2.0)y.Results Theperioperative mortality had no statistical difference between2groups(P=0.569).IMR,left ventricular ejectionfraction(LVEF)and left ventricular end-diastolic inner diameter(LVEDd)were significantly ameliorated in2groups before discharging from the hospital.LVEF was higher in MVP group than that in MVR group(P=0.016).There were3died cases during follow-up period.The long-term incidence of IMR was higher in MVP groupthan that in MVR group(P=0.020).LVEF and LVEDd had no statistical difference between2groups during finalfollow-up(P=0.981,P=0.596).Conclusion MVR and MVP have similar risk in patients with IMR complicated byventricular aneurysm.There is long-term recrudescence risk after MVP,while there is no significant difference inlong-term survival and heart function between MVR and MVP.