2021 年第 7 期 第 16 卷

老年退行性二尖瓣关闭不全患者行二尖瓣成形术与置换术的对比研究

Comparison between mitral valve plasty and mitral valve replacement in elderly patients with degenerative mitral regurgitation

作者：许金国1张成鑫1盛哲2龚文辉1刘海渊1刘状1黎蕾1贾山山1刘善东1张士兵1朱正艳1葛圣林1

英文作者：Xu Jinguo1 Zhang Chengxin1 Sheng Zhe2 Gong Wenhui1 Liu Haiyuan1 Liu Zhuang1 Li Lei1 Jia Shanshan1 Liu Shandong1 Zhang Shibing1 Zhu Zhengyan1 Ge Shenglin1

单位：1安徽医科大学第一附属医院心脏大血管外科，合肥230022；2安徽医科大学第一附属医院心脏彩超室，合肥230022

英文单位：1Department of Cardiovascular Surgery the First Affiliated Hospital of Anhui Medical University Hefei 230022 China; 2Cardiac Ultrasound Room the First Affiliated Hospital of Anhui Medical University Hefei 230022 China

关键词：退行性二尖瓣关闭不全；二尖瓣成形术；二尖瓣置换术；老年

英文关键词：Degenerativemitralregurgitation；Mitralvalveplasty；Mitralvalvereplacement；Elderly

• 摘要：

• 目的 探讨老年退行性二尖瓣关闭不全患者行二尖瓣成形（MVP）术与二尖瓣置换（MVR）术的临床效果差异。方法 回顾性分析2018年1月至2020年9月在安徽医科大学第一附属医院心脏大血管外科行手术治疗的95例65岁以上退行性二尖瓣关闭不全患者。收集所有患者围术期手术资料，将患者按照手术方法 分为MVR组和MVP组，利用倾向性评分匹配（PSM）筛选2组患者，分析两种手术方式围术期差异及随访3～6个月后对心功能的影响。结果 95例患者中，行MVP术者31例，MVR术64例，体外循环时间（117±32）min，升主动脉阻断时间（77±26）min，围术期死亡3例（3.2%）。PSM前，2组呼吸机使用时间、重症监护病房停留时间、术后第1天引流量、术后主要不良事件发生率、术后病死率差异均无统计学意义（均P＞0.05），但MVP组体外循环时间、升主动脉阻断时间均明显长于MVR组［（137±33）min比（108±28）min、（91±30）min比（71±22）min］（均P＜0.05）。PSM后，2组体外循环时间及升主动脉阻断时间差异亦无统计学意义（均P＞0.05）。随访3～6个月后，2组左心房内径、左心室舒张末期内径、每搏输出量、左心室射血分数、肺动脉收缩压、纽约心脏病协会心功能分级差异均无统计学意义（均P＞0.05），但MVP组左心室收缩末期内径、二尖瓣峰值跨瓣压差明显低于MVR组，左心室缩短分数明显高于MVR组（均P＜0.05）。结论 老年退行性二尖瓣关闭不全患者行MVP术与MVR术围术期治疗结果无明显差异，但MVP术具有更佳的血流动力学，且后期可能对左心功能起到保护作用。

• Objective To investigate the difference of clinical effect between mitral valve plasty (MVP) and mitral valve replacement (MVR) in elderly patients with degenerative mitral regurgitation. Methods From January 2018 to September 2020, 95 elderly patients over 65 years old with degenerative mitral regurgitation undergoing surgerical therapy in Department of Cardiovascular Surgery, the First Affiliated Hospital of Anhui Medical University were retrospectively analyzed. Perioperative data of patients were collected and patients were divided into MVR group and MVP group according to the operation method. Patients in both groups were screened by propensity score matching (PSM). The perioperative differences between the two operation methods and the influence on cardiac function after 3-6 months of follow-up were analyzed. Results Of the 95 patients, 31 cases underwent MVP and 64 cases underwent MVR. The extracorporeal circulation time was （117±32）min, ascending aortic occlusion time was （77±26）min, and 3 cases(3.2%) died during perioperative period. Before PSM, there were no significant differences in ventilator use time, length of intensive care unit stay, postoperative drainage volume on the first day, major adverse events and postoperative mortality between the two groups (all P＞0.05), but the cardiopulmonary bypass time and ascending aortic occlusion time in MVP group were significantly longer than those in MVR group［（137±33）min vs （108±28）min,（91±30）min vs （71±22）min］（both P＜0.05）. After PSM, there were no significant differences in cardiopulmonary bypass time and aortic occlusion time between the two groups (both P＞0.05). After 3-6 months of follow-up, there were no significant differences in left atrial diameter, left ventricular end diastolic diameter, stroke volume, left ventricular ejection fraction, pulmonary arterial systolic pressure, and New York Heart Association cardiac function classification between the two groups (all P＞0.05), but the left ventricular end systolic diameter, mitral peak transvalvular pressure difference in MVP group were significantly lower than those in MVR group, and left ventricular shortening fraction in MVP group were significantly higher than that in MVR group (all P＜0.05). Conclusions There is no significant difference in perioperative outcome between MVP and MVR in elderly patients with degenerative mitral regurgitation. MVP has better hemodynamics and may protect left ventricular function.