CAJ | 학술논문

目的探讨并总结二尖瓣成形术治疗中、重度黏液样退行性二尖瓣关闭不全远期疗效的影响因素.方法分析1993年1月至2008年1月261例因中、重度黏液样退行性二尖瓣关闭不全行二尖瓣成形术的患者临床资料和随访资料.结果围术期死亡7例,生存254例,生存患者二尖瓣成形效果良好.230例随访≥36个月,平均(77.3±30.3)个月,随访率90.6％；24例失访.多因素Cox regression分析显示,年龄≥60岁、左心室射血分数＜0.50、同期行冠状动脉旁路移植术是术后远期死亡的独立危险因素；左心室射血分数＜0.50、心功能(NYHA)Ⅲ-Ⅳ级、前瓣叶脱垂是术后远期二尖瓣再次中、重度反流的独立危险因素,成形环或塑形带成形是术后远期二尖瓣再次中、重度反流的保护因素.结论年龄≥60岁、左心室射血分数＜0.50、同期行冠状动脉旁路移植术、心功能分级Ⅲ-Ⅳ级、前瓣叶脱垂、成形环或塑形带成形等因素与中、重度黏液样退行性二尖瓣关闭不全患者二尖瓣成形术后远期不良事件密切相关.
목적 탐토병총결이첨판성형술치료중、중도점액양퇴행성이첨판관폐불전원기료효적영향인소.방법 분석1993년1월지2008년1월261례인중、중도점액양퇴행성이첨판관폐불전행이첨판성형술적환자림상자료화수방자료.결과 위술기사망7례,생존254례,생존환자이첨판성형효과량호.230례수방≥36개월,평균(77.3±30.3)개월,수방솔90.6％；24례실방.다인소Cox regression분석현시,년령≥60세、좌심실사혈분수＜0.50、동기행관상동맥방로이식술시술후원기사망적독립위험인소；좌심실사혈분수＜0.50、심공능(NYHA)Ⅲ-Ⅳ급、전판협탈수시술후원기이첨판재차중、중도반류적독립위험인소,성형배혹소형대성형시술후원기이첨판재차중、중도반류적보호인소.결론 년령≥60세、좌심실사혈분수＜0.50、동기행관상동맥방로이식술、심공능분급Ⅲ-Ⅳ급、전판협탈수、성형배혹소형대성형등인소여중、중도점액양퇴행성이첨판관폐불전환자이첨판성형술후원기불량사건밀절상관.
Objective To explore and conclude the influence factors of long-term outcomes of mitral valve repair for moderate and severe mitral regurgitation due to myxomatous degeneration.Methods To review the in-patient data and followup outcomes of 261 patients after mitral valve repair for moderate and severe mitral regurgitation due to myxomatous degeneration from Jan 1993 to Jan 2008 in Changhai Hospital of Second Military Medical University.Results There were 7 perioperative deaths and 254 survivors who obtained satisfactory perioperative outcomes.During the follow-up,24 patients were lost and 230 patients were followed up from 36 months to 174 months (77.3 ±30.3) months and follow-up rate was 90.6％.Multivariate Cox regression shows age ≥ 60 years old,left ventricular ejection fraction ＜ 0.50,undergoing combined coronary artery bypass grafting were the independent risk factors for long-term death after operations and left ventricular ejection fraction ＜ 0.50,New York Heart Association functional classification Ⅲ-Ⅳ,anterior leaflet prolapse were the independent risk factors for long-term recurrent moderate or severe mitral regurgitation after operations and prosthetic ring or band annulopasty was a protective factor.Conclusion The age ≥60 years old,left ventricular ejection fraction ＜ 0.50,undergoing combined coronary artery bypass grafting,New York Heart Association functional classification Ⅲ - Ⅳ,anterior leaflet prolapse,and prosthetic ring or band annulopasty were closely related with long-term adverse events after operations.