保留二尖瓣瓣下结构瓣膜置换术后患者中期生存状况的分析

Analysis on the medium-term survival of the patients receiving valve replacement with submitral valve structure preserved

目的了解保留二尖瓣瓣下结构瓣膜置换术后患者的中期生存状况。方法收集2013年8月至2015年8月因二尖瓣病变或二尖瓣及主动脉瓣双病变在高州市人民医院行手术治疗后并随访的患者731例,其中保留二尖瓣全瓣及瓣下结构组(组1)39例、保留二尖瓣后瓣及瓣下结构组(组2)346例、全切除二尖瓣及瓣下结构组(组3)346例。所有病例均应用双叶机械瓣。统计并比较各组中期超声测定心功能指标、电话随访生存率、心功能美国纽约心脏病学会(NYHA)分级、并发症发生率以及失访率。结果左室短轴缩短率(%):组1为(36.51±10.54)、组2为(27.69±7.57)、组3为(29.59±5.17),各组间差异有统计学意义(P<0.01)。Ⅰ级心功能(NYHA)占比:组1为93.94%、组2为94.65%、组3为91.11%,各组间差异无统计学意义(P>0.05)。生存率:组1为91.67%、组2为98.45%、组3为97.67%,组1与组2、3间差异有统计学意义(P<0.05)。全部病例中无出血并发症发生。结论在中期随访中,超声测定心功能指标左室短轴缩短率保留全瓣及瓣下结构优于其他组;临床心功能NYHA分级情况各组相仿;尽管保留瓣下结构组尤其保留全瓣组的中期生存率较低,但应考虑到其重症患者较多、术前心功能较差的因素。保留二尖瓣瓣下结构的瓣膜置换术,对中期患者生存是有益的。

Objective To study the medium-term survival of patients receiving valve replacement with submitral valve structure preserved.Methods A total of 731 patients who underwent valve replacement with submitral valve structure retained in Gaozhou People’s Hospital from August 2013 to August 2015 were selected as subjects,of which there were 39 cases with total mitral valve and subvalvular structures preserved(Group 1),346 cases with posterior mitral valve and subvalvular structures preserved(Group 2)and 346 cases with complete excision of mitral valve and subvalvular structures(Group 3).All the patients were implanted with the bileaflet mechanical valves.The ultrasound measurement of cardiac function indicators,the survival rate by telephone follow-up,NYHA grading,the incidence of complications and the rate of loss to follow-up of each group in medium term were compared among the three groups.Results The LVFS(%)of the Group 1,2 and 3 was(36.51±10.54),(27.69±7.57)and(29.59±5.17),respectively,and there was statistical difference among the three groups(P<0.01).The proportion of the cardiac function NYHA GradeⅠin the Group 1,2 and 3 was 93.94%,94.65%and 91.11%,respectively,and there was no statistical difference among the three groups(P>0.05).The survival rate of the Group 1,2 and 3 was 91.67%,98.45%and 97.67%,respectively,and there was statistical difference between the Group 1 and other two groups(P<0.05).All the patients had no complication of hemorrhage in this study.Conclusion In the medium-term follow up,the group with total mitral valve and subvalvular structures preserved has the LVFS superior to the other two groups.The three groups have similar NYHA grading of clinical cardiac function.The groups with subvalvular structures preserved,especially the group with the total mitral valve preserved,have a relative low medium-term survival rate,but considering to such factors that more patients have severe diseases and have a relatively poor cardiac function before the operation,the valve replacement with the submitral valve structure preserved is beneficial for the medium-term survival of patients.