缺血性二尖瓣关闭不全的治疗（英文）

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1、ISCHEMICMITRALREGURGITATION首都医科大学附属北京安贞医院心外科甘辉立PURPOSEIsvalverepairsuperiortovalvereplacementforischemicmitralregurgitation?DEFINITIONPreviousMINormalMVMECHANISMRupturedpapillarymuscleInfarctedpapillarymuscleFunctionalFunctionalPapInfarctPapRuptureMECHA

2、NISM27%8%65%REGURGITANTJETCentralPosteriorComplexAnterior7%58%15%20%Anterior40%Inferior73%Posterior63%Septal42%Lateral44%WALLMOTIONABNORMALITIESMITRALVALVEPROCEDURE39785REPAIRTECHNIQUES%Annuloplasty98Papmuscleshortening10Chordalshortening8Leafletresecti

3、on5Papmusclereimplant2ANNULOPLASTYSIZESIZE(mm)OPERATIVEMORTALITY8%26%P<.0001OPERATIVEMORTALITYReplacement26%Repair8%P<.0001SURVIVAL%Years716049YearsSURVIVAL%Years605446Years746150RepairReplacementSURVIVALPaprupturePapinfarctFunctionalMR%YearsRISKFACTORS

4、AdvancedAgeHigherNYHAfunctionalclassGreaterLVdysfunctionRenaldysfunctionAtrialfibrillationMitralvalvereplacementRISKFACTORSAFTERMITRALREPAIRComplexregurgitantjetLateralinfarctBovinepericardialannuloplastyNoITAgraftREPAIRvsREPLACEMENT%MATCHEDQUINTILESI%

5、III–V%EmergentStatus330.3FunctionalMR1686RupturedPap4813InfarctedPap382ITAGraft1655Repair4196002040608010001234567020406080100012345670204060801001234567SURVIVAL:MATCHEDQUINTILESIIIIII-VRepairReplacePREDICTEDSURVIVALrepairreplacement%Yearsreplacementr

6、epairPREDICTEDSURVIVAL%YearsDifferenceRepairBenefitReplaceBenefit7YEARSURVIVAL%REPAIRFAILURE959288%YearsCONCLUSIONSSurvivalispoorMostbenefitfromrepairInsickestpatients,survivalsimilarwithrepairandreplacementREMAININGQUESTIONSIntermittentischemicMR2+isch

7、emicMRatCABGChordalpreservationatMVRMechanismsofischemicMR