关键词: 缺血性二尖瓣关闭不全, 二尖瓣环成形术, 左室成形术

Abstract: The aim was to study a more effective surgical approach to treat Chronic ischemic mitral regurgitation(IMR) secondary to ischemic cardiomyopathy. Forty-six patients 〔(64±10) years〕 with previous anterior transmural myocardial infarction and mitral regurgitation compose the study group. Indication for surgery was heart failure in 93% of pts; 25 patients were in NYHA class Ⅳ. Mitral regurgitation was moderate to severe in 32 patients (70%). This surgical approach consisted in endoventricular mitral annuloplasty without prosthetic ring combined with ventricular reconstruction, and coronary artery bypass grafting(CABG). Global perioperative mortality rate was 15.2%; it was 20.0% in patients with EF<30% and 11.5% in patients with EF≥30%. End diastolic and end systolic volumes significantly decreased after surgery(P< 0.001); Pulmonary pressure decreased significantly(P< 0.05). Postoperative MR was absent or minimal in 85% of patients; Late mortality was 15%; Mid-term overall survival rate of 71% seemed promising in this series of patients at extremely high risk for mortality and subsequent cardiac events. This complex surgical procedure has a relatively high operative mortality, but the results are promising. The results of mitral repair should persist over time because the valve leaflets and the subvalvular apparatus are normal, and the two trigones are particularly strong to bear the tension of the stitch.

Key words: ischemic mitral regurgitation, mitral valve repair, left ventricle reconstruction