Journal of Chest Surgery

The Korean Society for Thoracic and Cardiovascular Surgery (대한심장혈관흉부외과학회)
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Outcomes of Combined Mitral Valve Repair and Aortic Valve Replacement

대동맥판막 치환술과 동반시행한 승모판막 성형술 결과

  • Baek, Man-Jong (Dept. of Thoracic and Cardiovascular Surgery, Sejong General Hospital, Sejong Heart Institute, Pucheon) ;
  • Na, Chan-Young (Dept. of Thoracic and Cardiovascular Surgery, Sejong General Hospital, Sejong Heart Institute, Pucheon) ;
  • Oh, Sam-Se (Dept. of Thoracic and Cardiovascular Surgery, Sejong General Hospital, Sejong Heart Institute, Pucheon) ;
  • Kim, Woong-Han (Dept. of Thoracic and Cardiovascular Surgery, Sejong General Hospital, Sejong Heart Institute, Pucheon) ;
  • Whang, Sung-Wook (Dept. of Thoracic and Cardiovascular Surgery, Sejong General Hospital, Sejong Heart Institute, Pucheon) ;
  • Lee, Cheol (Dept. of Thoracic and Cardiovascular Surgery, Sejong General Hospital, Sejong Heart Institute, Pucheon) ;
  • Chang, Yun-Hee (Dept. of Thoracic and Cardiovascular Surgery, Sejong General Hospital, Sejong Heart Institute, Pucheon) ;
  • Jo, Won-Min (Dept. of Thoracic and Cardiovascular Surgery, Sejong General Hospital, Sejong Heart Institute, Pucheon) ;
  • Kim, Jae-Hyun (Dept. of Thoracic and Cardiovascular Surgery, Sejong General Hospital, Sejong Heart Institute, Pucheon) ;
  • Seo, Hong-Ju (Dept. of Thoracic and Cardiovascular Surgery, Sejong General Hospital, Sejong Heart Institute, Pucheon) ;
  • Kim, Soo-Cheol (Dept. of Thoracic and Cardiovascular Surgery, College of Medicine, Kyunghee University) ;
  • Lim, Cheong (Dept. of Thoracic and Cardiovascular Surgery, Seoul National University Hospital, Seoul National University) ;
  • Kim, Wook-Sung (Dept. of Thoracic and Cardiovascular Surgery, Ilsan Paik Hospital, Inje University) ;
  • Lee, Young-Tak (Dept. of Thoracic and Cardiovascular Surgery, Samsung Medical Center, School of Medicine, Sungkyunkwan University) ;
  • Choi, Hyun-Seok (Dept. of Anesthesiology and Pain Clinic, College of Medicine, Hallym University) ;
  • Moon, Hyun-Soo (Dept. of Anesthesiology and Pain Clinic, College of Medicine, Hallym University) ;
  • Park, Young-Kwan (Dept. of Thoracic and Cardiovascular Surgery, Sejong General Hospital, Sejong Heart Institute, Pucheon) ;
  • Kim, Chong-Whan (Dept. of Thoracic and Cardiovascular Surgery, Sejong General Hospital, Sejong Heart Institute, Pucheon)
  • 백만종 (부천세종병원 흉부외과, 심장연구소) ;
  • 나찬영 (부천세종병원 흉부외과, 심장연구소) ;
  • 오삼세 (부천세종병원 흉부외과, 심장연구소) ;
  • 김웅한 (부천세종병원 흉부외과, 심장연구소) ;
  • 황성욱 (부천세종병원 흉부외과, 심장연구소) ;
  • 이철 (부천세종병원 흉부외과, 심장연구소) ;
  • 장윤희 (부천세종병원 흉부외과, 심장연구소) ;
  • 조원민 (부천세종병원 흉부외과, 심장연구소) ;
  • 김재현 (부천세종병원 흉부외과, 심장연구소) ;
  • 서홍주 (부천세종병원 흉부외과, 심장연구소) ;
  • 김수철 (경희대학교 의과대학교 흉부외과) ;
  • 임청 (서울대학교 의과대학 흉부외과) ;
  • 김욱성 (인제대학교 의과대학 일산백병원 흉부외과) ;
  • 이영탁 (성균관대학교 의과대학 삼성서울병원 흉부외과) ;
  • 최현석 (한림대학교 의과대학 마취통증의학교실) ;
  • 문현수 (한림대학교 의과대학 마취통증의학교실) ;
  • 박영관 (부천세종병원 흉부외과, 심장연구소) ;
  • 김종환 (부천세종병원 흉부외과, 심장연구소)
  • Published : 2003.07.01
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Abstract

The long-term results of combined mitral valve repair and aortic valve replacement (AVR) have not been well evaluated. This study was performed to investigate the early and long-term results of mitral valve repair with AVR. Material and Method: We retrospectively reviewed 45 patients who underwent mitral valve repair and AVR between September 1990 and April 2002. The average age was 47 years: 28 were men and 17 women. Twelve patients had atrial fibrillation and three had a previous cardiac operation. The mitral valve disease consisted of pure insufficiency (MR) in 34 patients, mitral stenosis (MS) in 3, and mixed lesion in 8. Mitral valve disease was due to rheumatic origin in 24 patients, degenerative in 11, annular dilatation in 8, and ischemia or endocarditis in 2. The functional anatomy of mitral valve was annular dilatation in 31 patients, chordal elongation in 19, leaflet thickening in 19, commissural fusion in 13, chordal fusion in 10, chordal rupture in 6, and so on. Aortic prostheses used included mechanical valve in 32 patients, tissue valve in 12, and pulmonary autograft in one. The techniques of mitral valve repair included annuloplasty in 32 patients and various valvuloplasty of 54 techniques in 29 patients. Total cardiopulmonary bypass and aortic cross clamp time were 204$\pm$62 minute and 153$\pm$57 minutes, respectively. Result: Early death was in one patient due to low output syndrome (2.2%). After follow up of 57$\pm$37 months, late death was in one patient and the actuarial survival at 10 years was 96$\pm$4%. Recurrent MR developed grade II or III in 11 patients and moderate MS in 3. Three patients required reoperation for valve-related complications. The actuarial freedom from recurrent MR, MS, and reoperation were 64$\pm$11%, 86$\pm$8%, and 89$\pm$7% respectively. Conclusion: Combined mitral valve repair with AVR offers good early and long-term survival, and adequate techniques and selection of indication of mitral valve repair, especially in rheumatic disease, are prerequisites for better long-term results.

대동맥판막 치환술과 동반시행한 승모판막 성형술의 장기 결과에 대해서는 잘 알려져 있지 않다. 본 연구는 대동맥판막 및 승모판막 질환에서의 대동맥판막 치환술과 동반시행한 승모판막 성형술의 조기 및 장기 수술 결과에 대해 알아보고자 하였다. 대상 및 방법: 1990년 9월부터 2002년 4월까지 세종병원에서 대동맥판막 치환술과 승모판막 성형술을 받은 45명의 환자를 대상으로 후향적으로 조사하였다. 남녀비는 28 : 17명이었고 평균 연령은 47$\pm$17세였다. 심방세동은 12명에서 있었고 3명은 과거에 심장수술을 받았다. 승모판막 질환은 폐쇄부전 34명, 협착 3명, 폐쇄부전 및 협착 혼합형이 8명이었다. 승모판막 질환의 원인으로는 류머치스성 24명, 퇴행성 11명, 기능성 8명, 허혈성과 심내막염이 각각 1명이었으며 수술 소견상 판륜확장 31명, 건삭확장 19명, 판첨비후 19명, 교련응합 13명, 건삭융합 10명, 건삭판열 6명 등이었다. 수술은 모든 환자에서 대동맥판막(기계판막 32명, 조직판막 12명, 폐동맥자가판막 1명)을 치환하였고 승모판막 성형술은 판륜성형술이 32명에서, 판첨성형술은 29명에서 54건이 시행되었다. 총체외순환시간 및 대동맥차단시간은 각각 204$\pm$62분, 153$\pm$57분이었다. 결과: 조기사망은 1명(2.2%)으로 술 후 저심박증후군으로 사망하였다. 57$\pm$37개월을 추적조사한 결과 1명(2.3%)이 암으로 사망하였으며 10년 actuarial survival 96$\pm$4%였다. 승모판 폐쇄부전은 11명에서 II혹은 III를 보였고, 중등도의 승모판 협착은 3명에서 있었으며 판막 관련 재수술은 2명에서 승모판막 질환으로 1명에서 대동맥판막 질환으로 필요하였다. 승모판막 폐쇄부전과 협착으로부터의 자유도는 각각 64$\pm$11%와 86$\pm$8%였으며 재수술로부터의 자유도는 89$\pm$7%였다. 결론: 대동맥판막 치환술과 동반시행한 승모판막 성형술은 양호한 조기 및 장기 생존율을 보이며 향후 승모판막 폐쇄부전 및 협착 재발률을 더 낮추기 위해서는 특히 류머치스성 승모판막 질환 경우에는 성형술에 대한 적절한 술기 및 적응증의 선택이 중요하리라 생각된다.

Keywords

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