二尖瓣成形与置换术治疗重度缺血性二尖瓣反流近中期疗效比较

Near-to medium-term clinical results of mitral valvuloplasty and mitral valve replacement in treating patients with severe ischemic mitral regurgitation

目的:比较二尖瓣成形术与二尖瓣置换术治疗重度缺血性二尖瓣反流(IMR)患者的近中期临床结果,探讨其治疗方法的选择。方法:2010年至2017年,成人冠心病合并重度IMR接受冠状动脉旁路移植术及二尖瓣成形/置换术共106例,其中二尖瓣成形56例,二尖瓣置换50例。研究主要终点为左心室收缩末期容积指数(LVESVI),二级终点:死亡、中风、二尖瓣再次手术、心力衰竭、NYHA分级恶化、二尖瓣再次反流、生活质量。结果:两组患者术前基线资料差异无统计学意义。两组患者在术后30 d、1年复合心脏事件终点发生率方面差异无统计学意义(P=0.97)。术后1年LVESVI及LVEF改善、基于SF-12评分的生活质量,差异无统计学意义(P>0.05)。术后1年二尖瓣成形组再发中-重度二尖瓣反流明显高于二尖瓣置换组(P=0.002)。结论:对于重度缺血性二尖瓣反流,二尖瓣成形或置换术均可获得较好的近中期临床效果;全瓣保留二尖瓣置换术更低的远期中重度二尖瓣反流发生率可能使患者更多的获益,但要权衡人工瓣膜置换的利弊。

Objective:To compare the clinical result of mitral valvuloplasty and mitral valve replacement in treating patients with severe ischemic mitral regurgitation(IMR).Methods:From 2010 to 2017,a total of 106 adults with coronary heart disease combined with severe IMR received coronary artery bypass grafting and mitral valvuloplasty/replacement,including 56 mitral valvuloplasty and 50 mitral valve replacement.The primary endpoint of the study was the left ventricular end systolic volume index(LVESVI).And the secondary endpoint was death,stroke,mitral valve reoperation,heart failure,deterioration of the New York Heart Association(NYHA)functional classification,mitral valve re-regurgitation,and quality of life.Results:There was no difference between the two groups of patients in preoperative baseline data.No significant difference was observed between the two groups in the end rate of compound heart events after 30 days and 1 year(P=0.97).There was no significant difference in quality of life based on SF-12 score after 1 year LVESVI and left ventricular ejection score(P>0.05).One year after the operation,the recurrence moderate to severe mitral regurgitation of mitral valvuloplasty was significantly higher than that of mitral valve replacement(P=0.002).Conclusions:For severe mitral valve regurgitation,mitral valvuloplasty or replacement can get a better near-to medium-term clinical result.Mitral valve replacement with complete preservation of the subvalvular apparatus has lower forward-term incidence of medium-to-severe mitral valve regurgitation,which may benefit patients more,but the pros and cons of artificial valve replacement must be weighed.