缺血性二尖瓣关闭不全的治疗（英文）

ISCHEMICMITRALREGURGITATION 首都医科大学附属北京安贞医院心外科甘辉立 PURPOSE Isvalverepairsuperiortovalvereplacementforischemicmitralregurgitation DEFINITION PreviousMINormalMV MECHANISM RupturedpapillarymuscleInfarctedpapillarymuscleFunctional Functional PapInfarct PapRupture MECHANISM 27 8 65 REGURGITANTJET Central Posterior Complex Anterior 7 58 15 20 Anterior 40 Inferior 73 Posterior 63 Septal 42 Lateral 44 WALLMOTIONABNORMALITIES MITRALVALVEPROCEDURE 397 85 REPAIRTECHNIQUES Annuloplasty98Papmuscleshortening10Chordalshortening8Leafletresection5Papmusclereimplant2 ANNULOPLASTYSIZE SIZE mm OPERATIVEMORTALITY 8 26 P 0001 OPERATIVEMORTALITY Replacement26 Repair8 P 0001 SURVIVAL Years Years SURVIVAL Years 60 54 46 Years 74 61 50 Repair Replacement SURVIVAL Paprupture Papinfarct FunctionalMR Years RISKFACTORS AdvancedAgeHigherNYHAfunctionalclassGreaterLVdysfunctionRenaldysfunctionAtrialfibrillationMitralvalvereplacement RISKFACTORSAFTERMITRALREPAIR ComplexregurgitantjetLateralinfarctBovinepericardialannuloplastyNoITAgraft REPAIRvsREPLACEMENT MATCHEDQUINTILES I III V EmergentStatus 33 0 3 FunctionalMR 16 86 RupturedPap 48 13 InfarctedPap 38 2 ITAGraft 16 55 Repair 41 96 0 0 20 40 60 80 100 0 1 2 3 4 5 6 7 0 20 40 60 80 100 0 1 2 3 4 5 6 7 0 20 40 60 80 100 1 2 3 4 5 6 7 SURVIVAL MATCHEDQUINTILES I II III V Repair Replace PREDICTEDSURVIVAL repair replacement Years replacement repair PREDICTEDSURVIVAL Years Difference RepairBenefit ReplaceBenefit 7YEARSURVIVAL REPAIRFAILURE 95 92 88 Years CONCLUSIONS SurvivalispoorMostbenefitfromrepairInsickestpatients survivalsimilarwithrepairandreplacement REMAININGQUESTIONS In