摘要
目的对比分析冠状动脉旁路移植术(coronary artery bypass grafting,CABG)同期行二尖瓣置换术(mitral valve replacement,MVR)与二尖瓣成形术(mitral valvuloplasty,MVP)治疗冠状动脉粥样硬化性心脏病(冠心病)合并Ⅲb型缺血性二尖瓣反流(ischemic mitral regurgitation,IMR)患者的临床疗效。方法回顾性分析青岛阜外心血管病医院2015年1月至2018年6月90例冠心病合并中、重度Ⅲb型IMR患者的临床资料,根据治疗方式分为两组:41例行CABG同期MVR治疗为MVR组,49例行CABG同期MVP治疗为MVP组。比较两组患者围术期指标,术前及术后出院时超声心动图参数[左心室射血分数(left ventricular ejection fraction,LVEF)、左心室舒张末期内径(left ventricular end-diastolic diameter,LVEDD)、左心房内径、二尖瓣反流面积]。统计术后1年IMR复发情况。结果两组患者术中主动脉阻断时间、体外循环时间、移植血管支数、左乳内动脉使用率及术后呼吸机使用时间、住重症监护病房时间、住院时间、不良事件发生率比较,差异无统计学意义(P>0.05)。MVR组和MVP组围术期病死率分别为2.44%、4.08%,组间比较差异无统计学意义(P>0.05)。术后出院时及术后1年,两组患者的LVEDD、左心房内径、二尖瓣反流面积均较术前显著降低,术后1年时LVEF较术前显著升高,差异有统计学意义(P<0.05)。两组患者术后LVEF、LVEDD、左心房内径比较,差异无统计学意义(P>0.05);MVR组的二尖瓣反流面积、IMR程度显著低于MVP组,差异有统计学意义(P<0.05)。结论 CABG同期行MVR和MVP治疗冠心病并发Ⅲb型IMR患者的围术期安全性、病死率及术后心功能恢复差异不明显,MVR纠正反流的效果更好,MVP术后有复发中、重度IMR的风险。
Objectives To compare and analyze the clinical efficacy of coronary artery bypass grafting(CABG)with mitral valve replacement(MVR)and mitral valvuloplasty(MVP)in patients with coronary heart disease(CHD)with typeⅢb ischemic mitral regurgitation(IMR).Methods Clinical data of 90 patients with CHD and moderate-to-severe typeⅢb IMR from January 2015 to June 2018 in Qingdao Fuwai Cardiovascular Hospital were retrospectively analyzed.They were divided into two groups according to the surgery:41 patients underwent CABG with MVR as MVR group,49 patients underwent CABG with MVP as MVP group.Perioperative indicators were compared between the two groups.Cardiac ultrasound parameters[left ventricular ejection fraction(LVEF),left ventricular end-diastolic diameter(LVEDD),left atrial diameter(LAD),mitral regurgitation area(MRA)]were measured before surgery,after discharge and 1 year after surgery.The recurrence of IMR at 1 year after surgery was counted.Results There were no significant differences of the aortic cross clamp time(ACCT),extracorporeal circulation time(ECCT),number of graft vessels,the utilization rate of left internal mammary artery(LIMA),postoperative ventilator time,admission to intensive care unit(ICU),hospitalization and the incidence of adverse events between the two groups(P>0.05).The perioperative mortality of MVR group and MVP group were 2.44%and 4.08%,respectively,and there was no significant difference between the two groups(P>0.05).At the time of discharge and 1 year after surgery,LVEDD,LAD and MRA were significantly lower than before surgery,LVEF at 1 year after surgery was significantly higher than before surgery(P<0.05)in both the two groups.There were no significant differences in LVEF,LVEDD,LAD between the two groups(P>0.05),but MRA and IMR in MVR group were significantly lower than those in MVP group(P<0.05)after treatment.Conclusions The perioperative safety,mortality and postoperative cardiac function recovery are comparable between CABG with MVR and MVP in the treatment of patients with CHD and typeⅢb IMR.MVR has a better effect in correcting reflux,and there is a higher risk of recurrence of moderate and severe IMR after MVP.
作者
刘晓君
王刚
张涛
冯遵义
吕洪福
LIU Xiao-jun;WANG Gang;ZHANG Tao;FENG Zun-yi;LV Hong-fu(Department of Cardiovascular Surgery,Qingdao Fuwai Cardiovascular Hospital,Qingdao,Shandong 266034,China;Intensive Care Unit,Qingdao Fuwai Cardiovascular Hospital,Qingdao,Shandong 266034,China)
出处
《岭南心血管病杂志》
CAS
2021年第1期42-47,共6页
South China Journal of Cardiovascular Diseases
关键词
冠状动脉疾病
缺血性二尖瓣反流
冠状动脉旁路移植
二尖瓣置换
二尖瓣成形
coronary heart disease
ischemic mitral regurgitation
coronary artery bypass grafting
mitral valve replacement
mitral valve formation
