上海交通大学学报（医学版）

上海交通大学学报（医学版） >

2022 , Vol. 42 >Issue 5: 629 - 634

DOI: https://doi.org/10.3969/j.issn.1674-8115.2022.05.011

论著 · 临床研究

中度缺血性二尖瓣关闭不全合并左室收缩功能减退的外科治疗效果分析

  • 姚皓弋 ,
  • 刘赟 ,
  • 秦凯捷 ,
  • 周密 ,
  • 王哲 ,
  • 陈安清 ,
  • 赵强 ,
  • 李海清
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  • 上海交通大学医学院附属瑞金医院心脏外科，上海 200025
姚皓弋（1990—），男，主治医师，博士；电子信箱：leon780_cn@sina.com。
李海清，电子信箱：drlihaiqing@163.com。

收稿日期: 2021-11-29

  录用日期: 2022-04-28

  网络出版日期: 2022-05-28

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Surgical treatment of moderate ischemic mitral regurgitation complicated with reduced left ventricular ejection fraction

  • Haoyi YAO ,
  • Yun LIU ,
  • Kaijie QIN ,
  • Mi ZHOU ,
  • Zhe WANG ,
  • Anqing CHEN ,
  • Qiang ZHAO ,
  • Haiqing LI
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  • Department of Cardiovascular Surgery, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, 200025, China
LI Haiqing, E-mail；drlihaiqing@163.com.

Received date: 2021-11-29

  Accepted date: 2022-04-28

  Online published: 2022-05-28

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摘要

目的·探索左室收缩功能减退的慢性中度缺血性二尖瓣关闭不全（ischemic mitral regurgitation，IMR）冠心病患者不同手术方式的疗效。方法·纳入2013年5月—2019年5月于上海交通大学医学院附属瑞金医院心脏外科行外科治疗的左室射血分数（left ventricular ejection fraction，LVEF）<50%的慢性中度IMR患者31例。根据是否合并二尖瓣成形（mitral valve plasty，MVP）手术，分为非体外冠状动脉旁路移植（off-pump coronary artery bypass grafting，OPCABG）组与CABG+MVP组。收集术前、术后以及随访时心脏超声资料和围术期并发症情况，评价手术疗效。结果·OPCABG组12例患者，CABG+MVP组19例。术后CABG+MVP组死亡1人，较于OPCABG组，死亡率无显著差异（5.3% vs 0），但二尖瓣反流程度显著减轻（P=0.000），重症监护室（intensive care unit，ICU）停留时间显著延长［3.0（1.0，4.0）d vs 1.0（1.0，2.0）d，P=0.027］。随访时间为48.7（30.2，66.5）个月，2组患者的死亡率、二尖瓣反流程度、LVEF以及各并发症比较差异无统计学意义。结论·OPCABG术治疗LVEF降低的慢性中度IMR患者并发症比CABG+MVP少，有利于患者快速康复，近中期疗效满意。

关键词： 缺血性二尖瓣关闭不全; 左室收缩功能减退; 非体外循环下冠状动脉旁路移植术; 二尖瓣成形术; 术后快速康复

本文引用格式

姚皓弋 , 刘赟 , 秦凯捷 , 周密 , 王哲 , 陈安清 , 赵强 , 李海清 . 中度缺血性二尖瓣关闭不全合并左室收缩功能减退的外科治疗效果分析[J]. 上海交通大学学报（医学版）, 2022 , 42(5) : 629 -634 . DOI: 10.3969/j.issn.1674-8115.2022.05.011

Abstract

Objective

·To explore different surgical strategies in patients of moderate ischemic mitral regurgitation (IMR) complicated with reduced left ventricular ejection fraction (LVEF).

Methods

·From May 2013 to May 2019, 31 patients diagnosed as moderate IMR with LVEF <50% received surgical treatment in Department of Cardiovascular Surgery in Ruijin Hospital, Shanghai Jiao Tong University School of Medicine. The patients were divided into off-pump coronary artery bypass grafting (OPCABG) group and CABG+mitral valve plasty (MVP) group according to whether or not mitral valve procedure was performed. Preoperative, postoperative and follow-up echocardiography data and perioperative complications were compared to evaluate the surgical efficacy.

Results

·There were 12 patients in OPCABG group and 19 patients in CABG+MVP group. 1 patient died in CABG+MVP group postoperatively, which showed no significant difference in mortality (5.3% vs 0) between the groups. The degree of mitral regurgitation was significantly reduced in CABG+MVP group (P=0.000), while intensive care unit (ICU) length of stay significantly increased [3.0 (1.0, 4.0) d vs 1.0 (1.0, 2.0) d, P=0.027]. After 48.7 (30.2, 66.5) months of follow-up, there were no significant differences in mortality, degree of mitral regurgitation, LVEF and complications between the two groups.

Conclusion

·OPCABG procedure treating chronic moderate IMR with reduced LVEF could be beneficial for enhanced recovery after surgery and has satisfactory early and mid-term efficacy.

Key words： ischemic mitral regurgitation; reduced left ventricular ejection fraction; off-pump coronary artery bypass grafting; mitral valve annuloplasty; enhanced recovery after surgery

参考文献

1 ARONSON D, GOLDSHER N, ZUKERMANN R, et al. Ischemic mitral regurgitation and risk of heart failure after myocardial infarction[J]. Arch Intern Med, 2006, 166(21): 2362-2368.
2 HUNG J W. Ischemic (functional) mitral regurgitation[J]. Cardiol Clin, 2013, 31(2): 231-236.
3 MERIS A, AMIGONI M, VERMA A, et al. Mechanisms and predictors of mitral regurgitation after high-risk myocardial infarction[J]. J Am Soc Echocardiogr, 2012, 25(5): 535-542.
4 SHARMA H, RADHAKRISHNAN A, NIGHTINGALE P, et al. Mitral regurgitation following acute myocardial infarction treated by percutaneous coronary intervention-prevalence, risk factors, and predictors of outcome[J]. Am J Cardiol, 2021, 157: 22-32.
5 AMIGONI M, MERIS A, THUNE JJ, et al. Mitral regurgitation in myocardial infarction complicated by heart failure, left ventricular dysfunction, or both: prognostic significance and relation to ventricular size and function[J]. Eur Heart J, 2007, 28(3): 326-333.
6 NEUMANN F J, SOUSA-UVA M, AHLSSON A, et al. 2018 ESC/EACTS guidelines on myocardial revascularization[J]. Eur Heart J, 2019, 40(2): 87-165.
7 VAHANIAN A, BEYERSDORF F, PRAZ F, et al. 2021 ESC/EACTS Guidelines for the management of valvular heart disease[J]. Eur Heart J, 2022, 43(7): 561-632.
8 BAKAEEN F G, GAUDINO M, WHITMAN G, et al. 2021: The American Association for Thoracic Surgery Expert Consensus Document: coronary artery bypass grafting in patients with ischemic cardiomyopathy and heart failure[J]. J Thorac Cardiovasc Surg, 2021, 162(3): 829-850.e1.
9 HICKS K A, TCHENG J E, BOZKURT B, et al. 2014 ACC/AHA key data elements and definitions for cardiovascular endpoint events in clinical trials: a report of the American college of cardiology/American heart association task force on clinical data standards (writing committee to develop cardiovascular endpoints data standards)[J]. J Am Coll Cardiol, 2015, 66(4): 403-469.
10 Ministry of Health of the People's Republic of China. Diagnostic standard of Hospital Acquired Infection (for Trial Implementation)[J]. Natl Med J China, 2001, 81(5): 314-320.
11 NADIM M K, FORNI L G, BIHORAC A, et al. Cardiac and vascular surgery-associated acute kidney injury: the 20th international consensus conference of the ADQI (acute disease quality initiative) group[J]. J Am Heart Assoc, 2018, 7(11): e008834.
12 PIéRARD L A, CARABELLO B A. Ischaemic mitral regurgitation: pathophysiology, outcomes and the conundrum of treatment[J]. Eur Heart J, 2010, 31(24): 2996-3005.
13 DAL-BIANCO J P, LEVINE R A. Anatomy of the mitral valve apparatus[J]. Cardiol Clin, 2013, 31(2): 151-164.
14 KUMANOHOSO T, OTSUJI Y, YOSHIFUKU S, et al. Mechanism of higher incidence of ischemic mitral regurgitation in patients with inferior myocardial infarction: quantitative analysis of left ventricular and mitral valve geometry in 103 patients with prior myocardial infarction[J]. J Thorac Cardiovasc Surg, 2003, 125(1): 135-143.
15 COMIN-COLET J, SáNCHEZ-CORRAL M A, MANITO N, et al. Effect of carvedilol therapy on functional mitral regurgitation, ventricular remodeling, and contractility in patients with heart failure due to left ventricular systolic dysfunction[J]. Transplant Proc, 2002, 34(1): 177-178.
16 PONIKOWSKI P, VOORS A A, ANKER S D, et al. 2016 ESC Guidelines for the diagnosis and treatment of acute and chronic heart failure[J]. Eur J Heart Fail, 2016, 18(8): 891-975.
17 KANG D H, PARK S J, SHIN S H, et al. Angiotensin receptor neprilysin inhibitor for functional mitral regurgitation[J]. Circulation, 2019, 139(11): 1354-1365.
18 CLELAND J G, ABRAHAM W T, LINDE C, et al. An individual patient meta-analysis of five randomized trials assessing the effects of cardiac resynchronization therapy on morbidity and mortality in patients with symptomatic heart failure[J]. Eur Heart J, 2013, 34(46): 3547-3556.
19 SUN H, GUAN Y Q, WANG L, et al. Influence of diabetes on cardiac resynchronization therapy in heart failure patients: a meta-analysis[J]. BMC Cardiovasc Disord, 2015, 15: 25.
20 AKLOG L, FILSOUFI F, FLORES K Q, et al. Does coronary artery bypass grafting alone correct moderate ischemic mitral regurgitation? [J]. Circulation, 2001, 104(12 Suppl 1): I68-I75.
21 FATTOUCH K, GUCCIONE F, SAMPOGNARO R, et al. POINT: Efficacy of adding mitral valve restrictive annuloplasty to coronary artery bypass grafting in patients with moderate ischemic mitral valve regurgitation: a randomized trial[J]. J Thorac Cardiovasc Surg, 2009, 138(2): 278-285.
22 CHAN K M J, PUNJABI P P, FLATHER M, et al. Coronary artery bypass surgery with or without mitral valve annuloplasty in moderate functional ischemic mitral regurgitation: final results of the Randomized Ischemic Mitral Evaluation (RIME) trial[J]. Circulation, 2012, 126(21): 2502-2510.
23 BOUCHARD D, JENSEN H, CARRIER M, et al. Effect of systematic downsizing rigid ring annuloplasty in patients with moderate ischemic mitral regurgitation[J]. J Thorac Cardiovasc Surg, 2014, 147(5): 1471-1477.
24 MICHLER R E, SMITH P K, PARIDES M K, et al. Two-year outcomes of surgical treatment of moderate ischemic mitral regurgitation[J]. N Engl J Med, 2016, 374(20): 1932-1941.
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