二尖瓣成形治疗风湿性二尖瓣狭窄合并小左室的近期临床效果分析

The short-term outcomes of mitral valvuloplasty for patients with rheumatic mitral stenosis and small left ventricle

目的:探讨二尖瓣成形术在风湿性二尖瓣狭窄合并小左室患者的围手术期及近期临床治疗效果。方法:回顾性分析2018年8月—2022年4月在郑州大学人民医院心脏中心心外科接受二尖瓣手术的67例风湿性二尖瓣狭窄合并小左室患者资料。其中30例行二尖瓣成形手术(MVP组),37例行二尖瓣置换术(MVR组)。收集两组患者术前、术中及术后1、3、6个月临床资料,进行对比分析。结果:两组患者在呼吸机使用时间、术后监护室滞留时间、术后病死率及应用辅助设备等方面均差异无统计学意义。MVP组体外循环时间及主动脉阻断时间均长于MVR组(均P<0.05);MVP组术后血管活性药使用时间、住院时间更短,术后瓣膜峰值流速更低,随访期间再住院及出血、血栓栓塞等情况发生率均更低(均P<0.05)。结论:二尖瓣成形术治疗风湿性二尖瓣狭窄合并小左室的临床疗效满意,相较于二尖瓣置换,虽然手术花费时间较长,但可以获得更好的血流动力学表现,并且有效地保护了左心功能,有利于患者术后早期心功能更快地恢复。

Objective:To investigate the perioperative and short-term clinical effects of mitral valvuloplasty for patients with rheumatic mitral stenosis and small left ventricle.Methods:This observational prospective study enrolled 67 patients with rheumatic mitral stenosis and small left ventricle who underwent mitral valve surgery from August 2018 to April 2022 at the Department of Cardiac Surgery,Fuwai Central China Hospital.Thirty patients underwent mitral valvuloplasty(MVP group) and 37 patients underwent mitral valve replacement(MVR group).The clinical data of the two groups before,during 1,3 and 6 months after operation were collected for comparative analysis.Results:In terms of ventilation time,ICU stay,mortality and application of auxiliary equipment after surgery,no significant difference was observed between the MVP and MVR groups.The cardiopulmonary bypass time and aortic cross-clamp duration was longer in the MVP group than those in the MVR group(both P<0.05).Conversely,the duration of vasoactive drug treament and hospital stay after surgery were shorter,the postoperative peak mitral valve velocity was lower,and the incidence of rehospitalization and bleeding or thromboembolism during follow-up were lower in the MVP group compared to the MVR group(all P<0.05).Conclusion:Mitral valvuloplasty is effective in treating rheumatic mitral stenosis with a small left ventricle.Mitral valvuloplasty is more time-consuming but brings better hemodynamic results compared with mitral valve replacement,which is conducive to early postoperative cardiac function recovery.