“衬裙”技术在成人二尖瓣置换中的应用及疗效评价

Application of“Chimney”technique in mitral valve replacement and evaluation of curative effect

目的 探讨及评估“衬裙”技术在二尖瓣置换中的安全性、有效性和近期手术效果。方法 回顾性分析武汉亚洲心脏病医院2019年1月至2020年12月64例行“衬裙”二尖瓣置换患者临床资料,其中男25例、女39例,年龄14~79(60.00±13.51)岁。所有患者均符合二尖瓣置换手术指征,且存在瓣膜与体表面积不匹配,即有效孔径面积指数(effective orifice area index,EOAI)<1.2 cm^(2)/m^(2)。所有手术均利用“衬裙”技术。收集患者基线资料、既往病史、术前及术后超声心动图结果、手术相关数据等指标。结果 所有患者均手术成功,术后无院内死亡。1例患者因出血行再次开胸探查术,术中发现主动脉倒T形切口靠左心房顶部最低点有活动性出血,余无明显出血;1例患者因术后出现快慢综合征行永久起搏器置入。全组患者体外循环时间为(174.39±47.53)min,主动脉阻断时间(110.39±47.53)min,平均二尖瓣移植物尺寸(28.03±1.27)mm。生物瓣置换50例,机械瓣置换14例。结论 “衬裙”技术在二尖瓣置换术中应用是安全有效的,可以获得较大尺寸的人工瓣膜置入,以取得更大的开口面积,从而具有良好的术后血流动力学特征和临床效果。

Objective To explore the safety, efficacy and short-term surgical outcomes of the“Chimney”technique in mitral valve replacement. Methods A retrospective analysis of the clinical date of 64 patients undergoing“Chimney”mitral valve replacement from January 2019 to December 2020 in Asia Heart Hospital was conducted, including 25 males and 39 females, aged 14-79(60.00±13.51) years old. All the patients were eligible for the mitral valve replacement surgery indication;there was a mismatch between the valve and the body surface area and the effective orifice area index(EOAI) was less than 1.2 cm^(2)/m^(2). All procedures were performed using the“Chimney”technique. The baseline data, past history, preoperative and postoperative cardiac ultrasound results as well as the procedure-related data were collected. Results All the patients were operated successfully and there was no early death in hospital. Re-thoracotomy due to bleeding was necessary in only 1 patient. One patient performed pacemaker implantation for postoperative fast-slow syndrome after the procedure. The cardiopulmonary bypass time was(174.39±47.53) min and the aortic clamping time was(110.39±47.53) min. The average diameters of the implanted mitral valve was(28.03 ± 1.27) mm. 50 cases were replaced with biological prostheses and 14cases were replaced with mechanical prostheses. Conclusion The“Chimney”technique is safe and effective in mitral valve replacement, which can avoid many complications and allow larger size of prosthesis implantation in the patients, resulting in good postoperative hemodynamic characteristics and midterm clinical results.