作者：庞帅，Muradyan Musheg，Muradyan Regina，陈宗皓，桑鹏超，谷腾飞，李嘉慧，袁金达

单位：

1.250021 山东省济南市槐荫人民医院心脏中心 2.119049 俄罗斯莫斯科，俄罗斯巴库列夫心血管外科研究中心 3.100029 北京市，首都医科大学附属北京安贞医院心脏外科 4.1335 德国柏林心脏中心心胸血管外科 5.451464 河南省郑州市，阜外华中心血管病医院心脏外科　 6.529000 广东省江门市五邑中医院心胸乳腺外科 通信作者：庞帅，E-mail：Pangshuai0507@163.com

Units：

1.Center for Cardiovascular Surgery, the People Hospital of Huaiyin, Jinan, Jinan 250021, China 2.Center for Cardiovascular Surgery, Bakulev, Russia, Moscow 119049, Russia 3.Cardiac Surgery, Beijing Anzhen Hospital, Capital Medical University, Beijing 100029, China 4.Department of Cardiothoracic and Vascular Surgery, German Heart Center Berlin (DHZB) , Berlin 1335, German 5.Cardiac Surgery, Fuwai Central China Cardiovascular Hospital, Zhengzhou 451464, China 6.Cardiothoracic and Breast Surgery, Jiangmen Wuyi Hospital of TCM, Jiangmen 529000, China Corresponding author: PANG Shuai, E-mail: Pangshuai0507@163.com

关键词：

二尖瓣闭锁不全; 退行性二尖瓣关闭不全; 二尖瓣成形术; 二尖瓣置换术; 远期预后; 疗效比较研究;

Keywords：

Mitral valve insufficiency; Degenerative mitral insufficiency; Mitral valve plasty; Mitral valvereplacement; Long term prognosis; Comparative effectiveness research

CLC：

DOI：

10.12114/j.issn.1008-5971.2022.00.017

Funds：

摘要：

背景退行性变是西方国家二尖瓣关闭不全常见的病因,与二尖瓣置换术(MVR)相比,二尖瓣成形术(MVP)不仅无需长期抗凝,避免了抗凝相关并发症,而且能够有助于左心功能的维护。目前MVR与MVP治疗退行性变的远期疗效尚不明确。目的比较MVP与MVR治疗退行性二尖瓣关闭不全的远期疗效。方法选取2003—2008年在俄罗斯巴库列夫心血管外科研究中心接受瓣膜手术的退行性二尖瓣关闭不全患者274例为研究对象。根据手术方式的不同,将患者分为MVP组(129例)和MVR组(145例)。收集患者一般资料,统计患者5年、10年累积生存率、无脑卒中发生率及再次瓣膜手术情况。分别根据患者随访终点时死亡情况、脑卒中发生情况,将患者分为死亡组(42例)和非死亡组(232例)、脑卒中组(30例)和非脑卒中组(244例)。采用单因素分析和多因素Cox回归分析探讨退行性二尖瓣关闭不全患者死亡、发生脑卒中的影响因素。结果 MVP组患者体外循环时间、主动脉阻断时间、术后住院时间长于MVR组(P <0.05)。死亡组患者体外循环时间、呼吸机使用时间长于非死亡组,MVP率低于非死亡组(P <0.05)。脑卒中组患者入院时血肌酐、入院时左心室射血分数(LVEF)高于非脑卒中组,MVP率低于非脑卒中组(P <0.05)。多因素Cox回归分析结果显示,MVP是退行性二尖瓣关闭不全患者死亡[HR=0.053,95%CI(0.005,0.585)]、发生脑卒中[HR=0.095,95%CI(0.013,0.698)]的保护因素(P <0.05)。MVP组患者5年累积生存率低于MVR组,10年累积生存率高于MVR组(P <0.05)。MVP组患者5年、10年累积无脑卒中发生率低于MVR组(P <0.05)。MVP组和MVR组患者再次瓣膜手术率比较,差异无统计学意义(P> 0.05)。结论 MVP是退行性二尖瓣关闭不全患者死亡、发生脑卒中的保护因素,对于退行性二尖瓣关闭不全患者,行MVP者的远期预后优于行MVR者,临床应积极推广MVP。

Abstract：

【Abstract】　Background Degenerative change is a common cause of mitral insufficiency in western countries.Compared with mitral valve replacement (MVR) , mitral valve plasty (MVP) not only does not need long-term anticoagulation,avoids anticoagulation related complications, but also contributes to the maintenance of left ventricular function. At present,the long-term efficacy of MVR and MVP is not clear.ObjectiveTo compare the long-term efficacy of MVP and MVR in thetreatment of degenerative mitral insufficiency.MethodsFrom 2003 to 2008, 274 patients with degenerative mitral insufficiencyunderwent valve surgery in Center for Cardiovascular Surgery, Bakulev, Russia were selected as the research objects. Accordingto the different operation methods, the patients were divided into MVP group (129 cases) and MVR group (145 cases) . Thegeneral data of patients were collected, and the 5-year and 10-year cumulative survival rates, the incidence of no stroke and revalve surgery were counted. According to the death and stroke at the end of follow-up, the patients were divided into death group(42 cases) , non death group (232 cases) , stroke group (30 cases) and non stroke group (244 cases) . Univariate analysis andmultivariate Cox regression analysis were used to explore the influencing factors of death and stroke in patients with degenerativemitral insufficiency. Results The cardiopulmonary bypass time, aortic occlusion time and postoperative hospital stay in MVPgroup were longer than those in MVR group (P < 0.05) . The cardiopulmonary bypass time and ventilator use time in the deathgroup were longer than those in the non death group, and the MVP rate was lower than that in the non death group (P < 0.05) .The serum creatinine and left ventricular ejection fraction (LVEF) in stroke group were higher than those in non stroke group,and the MVP rate was lower than that in non stroke group (P < 0.05) . Multivariate Cox regression analysis showed that MVPwas a protective factor for death [HR=0.053, 95%CI (0.005, 0.585) ] and stroke [HR=0.095, 95%CI (0.013, 0.698) ] in patientswith degenerative mitral insufficiency (P < 0.05) . The 5-year cumulative survival rate in MVP group was lower than that inMVR group, and the 10-year cumulative survival rate was higher than that in MVR group (P < 0.05) . The 5-year and 10-yearcumulative incidence of no stroke in MVP group was lower than that in MVR group (P < 0.05) . There was no significant differencein the rate of re-valve surgery between MVP group and MVR group (P > 0.05) . Conclusion MVP is a protective factor for deathand stroke in patients with degenerative mitral insufficiency. For patients with degenerative mitral insufficiency, the long-termprognosis of patients with MVP is better than those with MVR. MVP should be actively promoted in clinic.

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