改良全瓣保留技术在二尖瓣置换术中的应用
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摘要
目的对比分析改良全瓣保留技术、单纯后瓣保留技术及不保留瓣膜技术,探讨改良全瓣保留技术的手术疗效。方法将180例因风湿性二尖瓣病变接受二尖瓣机械瓣置换术的患者,根据术中对二尖瓣处理的方式不同分3组:改良全瓣保留技术组(全瓣保留组),单纯后瓣保留技术组(后瓣保留组),不保留瓣膜技术组(不保留组);回顾性分析3组患者手术治疗前、后及手术治疗中的临床及超声心动图资料,对比分析、总结改良全瓣保留技术的手术经验和近期疗效。结果全瓣保留组、后瓣保留组、不保留组术前资料差异无统计学意义(P> 0. 05);全瓣保留组阻断时间较后瓣保留组、不保留组长(P <0. 05),复苏时间较后瓣保留组、不保留组短(P <0. 05);全瓣保留组术后低心排综合征的发生率低于不保留组(P <0. 05);全瓣保留组术后无左室后壁破裂及机械瓣功能障碍发生;全瓣保留组术后6个月的左室收缩末径、左室舒张末径、左室收缩功能较后两组改善(P <0. 05)。结论改良全瓣保留技术的手术技术要求高,近期手术效果满意,适用于各类风湿性二尖瓣病变患者。
Objective To compare the efficacies among the modified total leaflets reserved technique,posterior leaflet reserve technique and no preservation technique for mitral valve replacement( MVR). Methods There were 380 patients treated with MVR for rheumatic mitral valve disease in our hospital from June 2014 to June 2017,among whom180 were enrolled and assigned into three groups in our study. Patients in Group A( n = 62),B( n = 80) and C( n = 38)received modified total leaflets reserved technique,posterior leaflet reserve technique and no preservation technique,respectively. The left ventricular end diastole diameter( LVEDd),left ventricular end systolic diameter( LVESd),left ventricular systolic function( LVEF) and other indicators of these three groups,before and after surgery,were collected. Results There was no significant difference among these three groups in clinical data before operation( P > 0. 05). The clamp time in Group A was significantly longer( P < 0. 05) and the recovery time was significantly shorter( P < 0. 05)when compared to Group B and C. The LVESd,LVEDd and LVEF of the Group A after operation were significantly improved when compared to the other two groups( P < 0. 05). Conclusion The modified total leaflets reserved technique has a satisfactory short-term effect when compared to the other two techniques.
Objective To compare the efficacies among the modified total leaflets reserved technique,posterior leaflet reserve technique and no preservation technique for mitral valve replacement( MVR). Methods There were 380 patients treated with MVR for rheumatic mitral valve disease in our hospital from June 2014 to June 2017,among whom180 were enrolled and assigned into three groups in our study. Patients in Group A( n = 62),B( n = 80) and C( n = 38)received modified total leaflets reserved technique,posterior leaflet reserve technique and no preservation technique,respectively. The left ventricular end diastole diameter( LVEDd),left ventricular end systolic diameter( LVESd),left ventricular systolic function( LVEF) and other indicators of these three groups,before and after surgery,were collected. Results There was no significant difference among these three groups in clinical data before operation( P > 0. 05). The clamp time in Group A was significantly longer( P < 0. 05) and the recovery time was significantly shorter( P < 0. 05)when compared to Group B and C. The LVESd,LVEDd and LVEF of the Group A after operation were significantly improved when compared to the other two groups( P < 0. 05). Conclusion The modified total leaflets reserved technique has a satisfactory short-term effect when compared to the other two techniques.
引文
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[7]Ozdemir AC,Emrecan B,Baltalarli A.Bileaflet versus posteriorleaflet-only preservation in mitral valve replacement[J].Tex Heart Inst J,2014,41(2):165-169.
[8]Chen L,Chen B,Hao J,et al.Complete preservation of the mitral valve apparatus during mitral valve replacement for rheumatic mitral regurgitation in patients with an enlarged left ventricular chamber[J].Heart Surg Forum,2013,16(3):E137-E143.
[9]Gomes OM,Santana Filho GP.New technical approach for crossed papillopexy in mitral valve replacement surgery:short term results[J].Braz J Cardiovasc Surg,2005,20(3):340-345.
[10]Kalcik M,Yesin M,Gunduz S,et al.Left Ventricular Side Obstructive Pannus Formation after Rheumatic Mitral Valve Replacement with Preservation of the Subvalvular Apparatus[J].Echocardiography,2015,32(12):1887-1888.
[11]Patel H,Antoine SM,Funk M,et al.Left ventricular outflow tract obstruction after bioprosthetic mitral valve replacement with preservation of the anterior leaflet[J].Rev Cardiovasc Med,2011,12(1):48-51.
[12]Lafci G,Cagli K,Cicek OF,et al.Papillary muscle repositioning as a subvalvular apparatus preservation technique in mitral stenosis patients with normal left ventricular systolic function[J].Tex Heart Inst J,2014,41(1):33-39.
[13]Soga Y,Nishimura K,Yamazaki K,et al.Simplified chordal reconstruction:'oblique'placement of artificial chordae tendineae in mitral valve replacement[J].Eur J Cardiothorac Surg,2003,24(4):653-655.
[14]李继勇,张健群,伯平,等.改良保留前叶技术在二尖瓣置换术中的应用[J].中国胸心血管外科临床杂志,2014,21(2):189-193.
[2]Alsaddique AA.Mitral valve replacement with the preservation of the entire valve apparatus[J].Rev Bras Cir Cardiovasc,2007,22(2):218-23.
[3]李继勇,张健群,伯平,等.不同保留瓣下结构方法行二尖瓣置换术的对比研究[J].心肺血管病杂志,2014,33(4):529-534.
[4]Coutinho GF,Bihun V,Correia PE,et al.Preservation of the subvalvular apparatus during mitral valve replacement of rheumatic valves does not affect long-term survival[J].Eur J Cardiothorac Surg,2015,48(6):861-7;discussion 867.
[5]Gunnal SA,Wabale RN,Farooqui MS.Morphological study of chordae tendinae in human cadaveric hearts[J].Heart Views,2015,16(1):1-12.
[6]Kessel SM,Hawkins RB,Yarboro LT,et al.Total Chordal Sparing Mitral Valve Replacement in Rheumatic Disease:A Word of Caution[J].Ann Thorac Surg,2017,104(1):e47-e48.
[7]Ozdemir AC,Emrecan B,Baltalarli A.Bileaflet versus posteriorleaflet-only preservation in mitral valve replacement[J].Tex Heart Inst J,2014,41(2):165-169.
[8]Chen L,Chen B,Hao J,et al.Complete preservation of the mitral valve apparatus during mitral valve replacement for rheumatic mitral regurgitation in patients with an enlarged left ventricular chamber[J].Heart Surg Forum,2013,16(3):E137-E143.
[9]Gomes OM,Santana Filho GP.New technical approach for crossed papillopexy in mitral valve replacement surgery:short term results[J].Braz J Cardiovasc Surg,2005,20(3):340-345.
[10]Kalcik M,Yesin M,Gunduz S,et al.Left Ventricular Side Obstructive Pannus Formation after Rheumatic Mitral Valve Replacement with Preservation of the Subvalvular Apparatus[J].Echocardiography,2015,32(12):1887-1888.
[11]Patel H,Antoine SM,Funk M,et al.Left ventricular outflow tract obstruction after bioprosthetic mitral valve replacement with preservation of the anterior leaflet[J].Rev Cardiovasc Med,2011,12(1):48-51.
[12]Lafci G,Cagli K,Cicek OF,et al.Papillary muscle repositioning as a subvalvular apparatus preservation technique in mitral stenosis patients with normal left ventricular systolic function[J].Tex Heart Inst J,2014,41(1):33-39.
[13]Soga Y,Nishimura K,Yamazaki K,et al.Simplified chordal reconstruction:'oblique'placement of artificial chordae tendineae in mitral valve replacement[J].Eur J Cardiothorac Surg,2003,24(4):653-655.
[14]李继勇,张健群,伯平,等.改良保留前叶技术在二尖瓣置换术中的应用[J].中国胸心血管外科临床杂志,2014,21(2):189-193.