多对人工腱索联合后交界折叠缝合行全胸腔镜Barlow病二尖瓣成形早期结果

Early clinical outcomes of totally thoracoscopic repair with leaflet folding,multiple artificial chordae implantation and ring annuloplasty for mitral regurgitation in Barlow disease

目的评价多对人工腱索联合后交界折叠缝合并辅以成形环的技术行全胸腔镜Barlow病(Barlow disease)二尖瓣成形的安全性和可行性。方法2018年6月至2019年12月,在全胸腔镜下,通过单操作孔,对连续10例Barlow病患者采用多对人工腱索置入、后交界折叠缝合并辅以成形环的技术行二尖瓣修复成形。通过对其早期结果的总结分析,评价其安全性和可行性。结果男8例,女2例;年龄(33.5±11.0)岁。全组无手术死亡及相关并发症。术中体外循环时间112~194 min,平均(142±26)min;阻断时间78~128 min,平均(96±18)min;置入人工腱索2~4对/例,平均(3.4±0.7)对/例。术中经食管超声心动图提示:二尖瓣对合高度0.8~1.5 cm,平均(1.2±0.2)cm。无二尖瓣关闭不全(mitral regurgitation,MR)及收缩期前向运动(systolic anterior motion,SAM)现象,平均跨瓣压差(1.2±0.4)mmHg(1 mmHg=0.133 kPa)。随访1~18个月,7例无MR,3例微量MR,平均跨瓣压差(1.5±0.6)mmHg。结论多对人工腱索联合后交界折叠缝合并辅以成形环的技术行全胸腔镜Barlow病二尖瓣成形是一种安全、有效的手术方法,可重复性好,早期结果满意,远期疗效有待进一步随访。

Objective To confirm the safety and feasibility of totally thoracoscopic repair with leaflet folding,multiple artificial chordae implantation and ring annuloplasty for mitral regurgitation(MR)in Barlow disease.Methods From June 2018 to December 2019,10 consecutive Barlow’s disease patients underwent totally thoracoscopic repair with leaflet folding,multiple artificial chordae implantation and ring annuloplasty.The safety and feasibility of this technique was evaluated by its early clinical outcomes.Results 8 males and 2 females.The mean age was(33.5±11.0)years.There was no operative death and related complications.The mean cardiopulmonary bypass(CPB)time was(142±26)(112-194)min,and the aortic clamping time was(96±18)(78-128)min.The average number of artificial chordae implantation was(3.4±0.7)(2-4)pairs/case.Intraoperative transesophageal echocardiography(TEE)showed the mean mitral valve coaptation length and transvalvular pressure gradient was(1.2±0.2)(0.8-1.5)cm and(1.2±0.4)mmHg(1 mmHg=0.133 kPa),respectively,without MR or systolic anterior motion(SAM).During a follow-up of 1-18 months,there were 7 cases with no MR and 3 with trace MR,with a mean transvalvular pressure gradient of(1.5±0.6)mmHg.Conclusion Totally thoracoscopic repair with leaflet folding,multiple artificial chordae implantation and ring annuloplasty was a safe and effective procedure with satisfied early clinical outcomes for MR in Barlow’s disease.However,further randomized and long-term follow-up studies were warranted to determine its clinical effects.