摘要
目的比较冠状动脉旁路移植术(CABG)复合二尖瓣成形术(MVP)与二尖瓣置换术(MVR)治疗冠状动脉粥样硬化性心脏病(CHD)合并中-重度缺血性二尖瓣关闭不全(IMR)的近期疗效。方法回顾性分析2018年1月至2020年1月郑州大学第一附属医院心血管外科收治的80例CHD合并中-重度IMR患者的临床资料,根据二尖瓣的处理方式分为MVP组(48例)和MVR组(32例)。比较两组患者术前一般资料,围术期指标,术前、出院时、随访1年的超声心动图指标,包括左心室舒张末期内径(LVEDD)、左心室射血分数(LVEF)、二尖瓣反流情况以及患者的纽约心脏病协会(NYHA)心功能分级。结果两组患者术前一般资料、围术期指标、术后并发症发生率及围术期病死率、术后及随访1年超声心动图指标比较,差异均无统计学意义(P>0.05)。患者治愈出院时,二尖瓣反流发生率MVP组高于MVR组(34.1%比3.3%,P<0.05),随访1年,MVP组二尖瓣轻度及以上反流发生率显著高于MVR组(69.0%比3.3%,P<0.05),MVR组患者心功能分级优于MVP组,心功能Ⅲ~Ⅳ级患者占比(6.7%比28.6%,P<0.05)。结论对于中-重度IMR患者,CABG联合MVP或者MVR均能取得较好的近期临床效果,但MVR术后再发二尖瓣关闭不全的风险较低,有较稳定和长期的获益。
Objective To compare the short-term efficacy of coronary artery bypass grafting(CABG) combined with mitral valvuloplasty(MVP) and mitral valve replacement(MVR) in the treatment of coronary heart disease(CHD) complicated with moderate to severe ischemic mitral regurgitation(IMR). Methods The clinical data of 80 patients with CHD complicated with moderate to severe IMR treated in the Department of Cardiovascular Surgery of the First Affiliated Hospital of Zhengzhou University from January 2018 to January2020 were retrospectively analyzed. According to the treatment of the mitral valve, of which, 48 cases were divided into the MVP group and 32 cases into the MVR group. The preoperative general data, perioperative indexes, echocardiographic indexes before operation and at discharge as well as 1-year follow-up were compared between the two groups, including left ventricular end diastolic diameter(LVEDD), left ventricular ejection fraction(LVEF), mitral regurgitation and the cardiac function grade of New York Heart Association(NYHA).Results There was no significant difference between the two groups in the preoperative general data,perioperative indexes, incidence of postoperative complications and perioperative mortality and postoperative and1-year follow-up cardiac ultrasound indexes(P> 0.05).When patients were cured and discharged, the incidence of mitral regurgitation in MVP group was higher than that in MVR group(34.1% vs. 3.3%, P<0.05). At 1 year followup, the incidence of mild or above mitral regurgitation in MVP group was significantly higher than that in MVR group(69.0% vs. 3.3%, P<0.05), and the cardiac function grading in MVR group was better than that in MVP group, with the proportion of patients with grade Ⅲ~Ⅳ cardiac function(6.7% vs. 28.6%, P<0.05). Conclusions For the patients with moderate to severe IMR, CABG combined with MVP or MVR both can achieve good shortterm clinical results, but the risk of recurrent mitral regurgitation after MVR is lower and has stable and longterm benefits.
作者
郭博文
周佳卫
邹程
詹海波
孙福强
姚星星
刘超
GUO Bo-wen;ZHOU Jia-wei;ZOU Cheng;ZHAN Hai-bo;SUN Fu-qiang;YAO Xing-xing;LIU Chao(Department of Cardiovascular Surgery,The First Affiliated Hospital of Zhengzhou University,Zhengzhou 450052,China)
出处
《中国心血管病研究》
CAS
2022年第2期148-153,共6页
Chinese Journal of Cardiovascular Research
