Artificial chordae transplantation and saddle ring annuloplasty in the treatment of degenerative mitral regurgitation

doi:10.3969/j.issn.2095-4344.2014.05.009

Abstract

Abstract:

BACKGROUND: Artificial chordae transplantation and saddle ring annuloplasty are the key steps in mitral valvuloplasty. However, there are no large-size studies addressing the safety, validity and efficacy of these treatments in China.

OBJECTIVE: To summarize the efficacy and safety of artificial chordae transplantation and saddle ring annuloplasty in the treatment of degenerative mitral regurgitation.

METHODS: Eighty-five patients with degenerative mitral regurgitation underwent mitral valve repair with artificial chordae (Gore-Tex sutures) transplantation and saddle ring (SJM^TM rigid saddle-shaped) annuloplasty from January 2009 to May 2013 in General Hospital of Shenyang Area Military Command, China. Operative technique included simple artificial chordae transplantation in 41 cases, artificial chordae transplantation plus quadrangular resection of the posterior leaflet in 22 cases, artificial chordae transplantation plus quadrangular resection of the posterior leaflet and sliding technique in 23 cases. All cases received saddle ring annuloplasty.

RESULTS AND CONCLUSION: Follow-up after treatment was done among 78 patients for 6 months to 4 years, with a follow-up rate of 91.7% (78/85). Among the 78 cases, one case died of cerebral infarction after 13 months, one died from accident, and the remaining 76 were alive. According to the evaluation of cardiac function (NYHA), 59 cases were in grade I and 17 cases were in grade II. Color ultrasound displayed that, no regurgitation was found in 67 cases, and mild regurgitation in 9 cases. The echocardiography showed that postoperative left atrium diameter (P < 0.05 or P < 0.01), left ventricular end-diastolic diameter (P < 0.05 or P < 0.01), left ventricular end-systolic diameter (P < 0.05 or P < 0.01), and the ratio of regurgitation beam area and left atrial area (P < 0.05 or P < 0.01), mean pulmonary artery pressure (P < 0.05 or P < 0.01) were significantly decreased compared with that before operation. Ejection fraction was significantly increased after operation (P < 0.05 or P < 0.01). No systolic anterior motion occurred. The postoperative complications included sinus bradycardia in 12 cases and paroxysmal supraventricular tachycardia in 25 cases, late cardiac tamponade in 1 case at 1 week postoperatively, and pacemarker implantation in 1 case (who exhibited bradycardia-tachycardia syndrome before operation). There was no ring rupture, ring avulsion, hemolysis, left ventricular outflow tract infarction and artificial chordae rupture or splitting. No cases needed reoperation on valve replacement. Application of artificial chordae transplantation and saddle ring annuloplasty is a safe and effective means for treating degenerative mitral regurgitation, with excellent midterm outcomes.

中国组织工程研究杂志出版内容重点：肾移植；肝移植；移植；心脏移植；组织移植；皮肤移植；皮瓣移植；血管移植；器官移植；组织工程

全文链接：

Key words: transplantation, mitral valve regurgitation, mitral valve annuloplasty, chordae tendineae

CLC Number:

R318

Han Jin-song, Wang Hui-shan, Yin Zong-tao, Han Hong-guang, Song Heng-chang. Artificial chordae transplantation and saddle ring annuloplasty in the treatment of degenerative mitral regurgitation[J]. Chinese Journal of Tissue Engineering Research, 2014, 18(5): 705-711.

Figures/Tables 1

2.1 治疗早期情况 85例患者中行人工腱索移植41例、行人工腱索移植+后叶楔形切除21例、行人工腱索移植+后叶楔形切除+滑行(Sliding)技术23例。每例使用Gore-Tex人工腱索为1-4根。对85例患者均行二尖瓣人工瓣环环缩技术，均使用SJMTM刚性鞍形成形环进行环缩术。在85例患者中使用30号环64例、使用32号环21例。同期行三尖瓣成形术40例(Kay成形术5例、Edwards MC3 三尖瓣瓣环环缩术35例)。平均体外循环时间为62-105 min，平均为(72±11) min；主动脉阻断时间为39-80 min，平均为(55±8) min。住院时间为9-21 d，平均为(15±4) d。治疗后早期无死亡病例。 2.2 随访结果出院后随访共78例，随访率为91.7% (78/85)。随访时间为6个月-4年。78例中，1例于治疗后13个月死于脑梗死，1例死于交通事故，余76例均存活。NYHA心功能分级Ⅰ级59例，Ⅱ级17例。复查超声心动图彩色多普勒血流成像测量提示二尖瓣微量反流及微量以下反流67例，二尖瓣轻度反流9例。三尖瓣无明显反流35例，微量反流1例，轻度反流4例。 2.3 人工腱索移植前后超声心动图测量指标比较见表2。门诊复查超声心动图显示治疗后各时间点与治疗前的指标比较，左心房内径明显减少(P < 0.05或P < 0.01)，左心室舒张末期内径明显减少(P < 0.05或P < 0.01)，左心室收缩末期内径明显减少(P < 0.05或P < 0.01)，二尖瓣反流束面积/左房面积明显减少(P < 0.05或P < 0.01)，肺动脉平均压明显降低(P < 0.05或P < 0.01)，射血分数明显增加(P < 0.05或P < 0.01)。所有病例均未出现二尖瓣前叶收缩期前向运动现象(SAM征)。 2.4 并发症及不良反应并发症情况：治疗后出现窦性心动过缓12例，阵发性室上性心动过速25例。其中3例阵发性室上性心动过速患者行同步电复律后好转。1例患者治疗前有心房颤动伴快-慢综合征，术后表现为间断的短暂意识丧失，心率变化较大，最快190次/min，最慢30次/min，动态心电图示R-R间期最长7 s，安装永久起搏器后好转。1例治疗后1周出现延迟性心包填塞的表现，经心包穿刺留置置管引流后治愈。不良反应情况：所有患者中均无成形环断裂、成形环撕脱、溶血、左室流出道梗死、人工腱索断裂或劈裂等不良事件发生。无因二尖瓣反流程度加重或避免撕裂需要再次手术行瓣膜置换术的患者。"

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