交叉植线行人工二尖瓣心房内植入术在治疗严重二尖瓣瓣环钙化中的应用

Intra-atrial insertion of a mitral prosthesis with cross suture technique in heavily mitral annular calcification

目的:描述通过交叉植线将人工二尖瓣植于左心房内来治疗以反流为主的二尖瓣瓣环钙化(MAC)患者的技术.方法:2019年8月至2021年1月,于首都医科大学附属北京安贞医院接收9例以二尖瓣反流为主行二尖瓣置换术的严重MAC患者,其中男性2例,女性7例,平均年龄(63.31±7.39)岁.9例患者均通过交叉植线将人工二尖瓣植于左心房内,其中6例为部分植入,3例为完全植入.有7例患者同期行其他手术.结果:手术全部成功.除1例长期接受持续性肾替代治疗的终末期肾病患者术后第二天因呼吸衰竭死亡外,其余患者均成功治愈.平均体外循环时间(151±69)min,阻断时间(109±51)min,手术时间(6.3±2.1)h,住重症监护室时间(1.9±0.7)d,住院时间(7.1±2.3)d.治愈患者围手术期内均未出现围手术期心肌梗死、围手术期脑梗死、急性肾衰竭、室性心律失常等并发症.结论:交叉植线将人工二尖瓣植于左心房内可以作为一种简单、安全、有效地治疗以二尖瓣反流为主的MAC的手术方式.

Objective:We herein describe an approach to perform intra-atrial insertion of a mitral valve replacement with cross suture technique in the presence of a heavily mitral annular calcification(MAC)in patients with predominant mitral regurgitation.Methods:Between August 2019 and January 2021,nine pa-tients suffering from predominant mitral regurgitation with heavily MAC underwent mitral valve replacement in Beijing Anzhen Hospital,Capital Medical University.The group comprised 2 men and 7 women with a mean age of(63.31±7.39)years.All patients underwent intra-atrial insertion of a mitral valves replacement with cross suture technique.Prosthetic mitral valves were partial implanted in left atrial in 6 patients and totally in the oth-er 3 patients.7 patients underwent concomitant other cardiac operations.Results:The rate of procedural success is 100%.All patients were successfully cured,except for one patient who treated with continuous renal replacement treatment preoperation for a long time and died on the second postoperative day due to respiratory failure.The mean extracorporeal circulation period in all patients was(151±69)minutes,ischemic period was(109±51)minutes,operative period was(6.3±2.1)hours,intensive care unit stay was(1.9±0.7)days,and hospital stay was(7.1±2.3)days.There had been no perioperative complications such as cerebral infarction,myocardial infarction,acute renal failure and ventricular arrhythmia in the cured patients.Conclusions:Intra-atrial insertion of a prosthetic mitral valve with cross suture technique can be simply,safely and successfully carried out in patients suffering from predominant regurgitation with heavily MAC.