Kitai Takeshi, Okada Yukikatsu, Shomura Yu, Tanabe Kazuaki, Tani Tomoko, Kita Toru, Furukawa Yutaka
Department of Cardiovascular Medicine, Kobe City Medical Center General Hospital, Kobe, Japan.
J Heart Valve Dis. 2012 Jan;21(1):61-70.
It remains controversial whether early mitral valve (MV) repair should be performed for severe degenerative mitral regurgitation (MR) without symptoms, left ventricular (LV) dilatation or dysfunction, atrial fibrillation (AF) or pulmonary artery hypertension (PH), even at experienced surgical centers. The study aim was to reconsider the optimal timing of intervention for asymptomatic patients with severe degenerative MR at experienced surgical centers.
Clinical outcomes were reviewed retrospectively for 298 consecutive asymptomatic patients (mean age 57 +/- 12 years) who underwent MV surgery for degenerative MR. The patients were allocated to two groups based on the following comorbid conditions: LVEF < or = 60%, LV end-systolic dimension 40 mm, AF, and PH. Group A comprised 122 patients with none of these conditions, while group B comprised 176 patients with any one of the conditions. The clinical outcomes were compared between the two groups at a mean of 7.0 +/- 4.5 years after surgery.
MV repair had been attempted in all patients, with a success rate of 100%. At 10 years, survival among group B patients was poorer than in group A (93% and 81%, respectively; p = 0.02), and there was a lower freedom from valve-related events (89% and 71%, respectively; p < 0.01). The independent predictors of valve-related events were preoperative AF (hazard ratio 3.34; p < 0.001) and age > 60 years (hazard ratio 2.50; p < 0.01).
Early MV repair is a reasonable option in asymptomatic patients, while preoperative AF may be a more appropriate predictor of an adverse outcome than LV function, as is currently recommended.
对于无症状、无左心室（LV）扩张或功能障碍、无房颤（AF）或肺动脉高压（PH）的严重退行性二尖瓣反流（MR）患者，即使在经验丰富的手术中心，早期二尖瓣（MV）修复术是否应实施仍存在争议。本研究目的是重新审视经验丰富的手术中心对无症状严重退行性MR患者的最佳干预时机。
回顾性分析298例因退行性MR接受MV手术的连续无症状患者（平均年龄57±12岁）的临床结局。根据以下合并症将患者分为两组：左心室射血分数（LVEF）≤60%、左心室收缩末期内径≥40mm、房颤、肺动脉高压。A组包括122例无上述任何情况的患者，B组包括176例有上述任何一种情况的患者。在术后平均7.0±4.5年时比较两组的临床结局。
所有患者均尝试进行MV修复，成功率为100%。10年时，B组患者的生存率低于A组（分别为93%和81%；p=0.02），且无瓣膜相关事件的生存率较低（分别为89%和71%；p<0.01）。瓣膜相关事件的独立预测因素为术前房颤（风险比3.34；p<0.001）和年龄>60岁（风险比2.50；p<0.
