摘要目的 总结二尖瓣修复术治疗退行性二尖瓣关闭不全的围手术期及远期疗效.方法 2003年1月至2015年12月,共1 903例患者因退行性二尖瓣关闭不全在我院行二尖瓣修复术.男1 312例(68.9％),女591例(31.1％);平均年龄(54.2±13.1)岁.总结围手术期结果及远期疗效并分析其危险因素.结果 全组住院病死率1.8％ (35/1 903),单纯二尖瓣修复的住院病死率0.9％(10/1 163).围手术期中枢系统并发症发生率0.7％,1.8％患者行气管切开,1.2％患者需血液透析治疗,0.7％患者因出血开胸探查.术前NYHA心功能分级Ⅲ～Ⅳ级(OR=3.65)、房颤(OR =2.85)及左心室射血分数(EF) ＜0.6(OR =2.34)是住院死亡的独立危险因素.术后12年,总生存率、再次二尖瓣手术豁免率及二尖瓣反流复发豁免率分别为85％、91％和75％.年龄＞60岁(HR=7.43)、术前卒中史(HR=6.51)、EF＜0.6(HR=3.87)、左心室收缩期末内径＞40mm(HR =3.98)及肺动脉收缩压＞50mmHg(1 mmHg =0.133 kPa)(HR=2.85)是远期死亡的独立预测因素.EF ＜0.6(HR=4.01)、左心室舒张期末内径＞ 60 mm(HR=1.88)、前叶病变(HR=2.40)和术中即刻残余轻度反流(HR =4.17)是远期二尖瓣关闭不全复发的独立预测因素.前叶病变(HR=3.35)是远期再次二尖瓣手术的预测因素.结论 退行性二尖瓣关闭不全行修复手术的安全性极佳.在经验丰富的中心对左心功能尚正常的无症状患者实施早期手术可进一步降低手术风险、提高修复耐久性并改善远期预后.

abstractsObjective The aim of the study is to evaluate the early and long-term outcomes of mitral valve repair for degenerative mitral regurgitation.Methods From January 2003 to December 2015,clinical profiles of 1 903 patients with degenerative mitral regurgitation who underwent mitral valve repair at our institution were analyzed retrospectively.There were 1 312 males (68.9 ％) and 591 females (31.1％) the mean age was (54.2 ± 13.1) years.Early and long-term outcomes were summarized and risk factors for adverse events were assessed.Results There were 35 in-hospital deaths(1.8％) and in-hospital mortality for isolated mitral valve repair was 0.9％ (10/1 163).Perioperative complications included central nerve system complications(0.7％),respiratory failure requiring tracheotomy(1.8％),acute renal injury requiring hemodialysis(1.2％) and reoperation for bleeding(0.7 ％).NYHA function class Ⅲ-Ⅳ (OR =3.65),atrial fibrillation (OR =2.85) and ejection fraction ＜0.6(OR =2.34) were identified as independent risk factors for in-hospital mortality.12 years over follow-up,overall survival,freedom from reoperation for mitral valve and freedom from recurrent moderate/severe regurgitation were 85％ 、91％ and 75％,respectively.Age ＞ 60 years(HR =7.43),preoperative stroke(HR =6.51),ejection fraction ＜ 0.6 (HR =3.87),left ventricular end-systolic dimension ＞ 40 mm (HR =3.98) and pulmonary systolic pressure ＞ 50 mmHg (1 mmHg =0.133 kPa) (HR =2.85) were independent predictive factors for late death.Ejection fraction ＜ 0.6 (HR =4.01),left ventricular end-diastolic dimension ＞ 60 mm(HR =1.88),leaflet lesion involving anterior leaflet (HR =2.40) and residue mild regurgitation(HR =4.17) were independent predictors for late recurrent regurgitation.Leaflet lesion involving anterior leaflet(HR =2.40) and residue mild regurgitation (HR =3.35) were independent predictor for late reoperation for mitral valve.Conclusion Mitral valve repair is safe and effective in degenerative mitral regurgitation.Early surgical intervention for asymptomatic patients with preserved left ventricular function before onset of atrial fibrillation and pulmonary artery hypertension is associated with decreased incidence of adverse events and improved long-term outcomes.Early surgical intervention should be restricted in experienced high-volume centers.