Division of Cardiac Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, Mass 02115, USA.
J Thorac Cardiovasc Surg. 2013 Sep;146(3):616-22. doi: 10.1016/j.jtcvs.2012.07.049. Epub 2012 Aug 24.
Both partial and complete annuloplasty rings are used for mitral valve repair for patients with functional mitral regurgitation (FMR). We sought to determine if recurrence of mitral regurgitation (MR) is affected by the type of ring used.
Five hundred forty-eight patients diagnosed with FMR underwent mitral valve repair with ring annuloplasty between 1998 and 2008 in our institution. Medical records were reviewed retrospectively for clinical and echocardiographic data to determine the presence of recurrent MR (defined as moderate or severe).
Among 479 patients for whom postoperative echocardiographic data were available, recurrent MR occurred less frequently in the complete versus partial ring group (20 of 209 [10%] vs 56 of 270 [21%] patients; P = .001), despite lower preoperative ejection fractions in the complete ring group (median, 35%; interquartile range, 25%-45% vs median, 40%; interquartile range, 30%-55%; P < .001). Kaplan-Meier analysis demonstrated greater freedom from recurrent MR in the complete ring group (108 vs 103 months; P = .001). Risk-matched propensity analysis of 102 patients per group (area under the curve, 0.824; 95% confidence interval, 0.788-0.861; P < .001) also demonstrated that complete ring recipients had greater freedom from recurrent MR than partial ring recipients by univariate analysis (7 [7%] vs 17 [17%] patients; P = .049), and a trend toward greater freedom by Kaplan-Meier analysis (110 vs 104 months; P = .068).
The use of complete mitral annuloplasty rings provides improved freedom from recurrent MR in patients with FMR.
部分和全环成形术环均用于治疗功能性二尖瓣反流（FMR）患者的二尖瓣修复。我们旨在确定二尖瓣反流（MR）的复发是否与所使用的环的类型有关。
1998 年至 2008 年，我们机构对 548 例 FMR 患者进行了二尖瓣修复手术，并采用环成形术进行二尖瓣环成形术。回顾性分析病历以获取临床和超声心动图数据，以确定是否存在复发性 MR（定义为中度或重度）。
在 479 例可获得术后超声心动图数据的患者中，全环组比部分环组的复发性 MR 发生率较低（20/209 [10%] 比 56/270 [21%]；P=.001），尽管全环组的术前射血分数较低（中位数，35%；四分位距，25%-45% 比中位数，40%；四分位距，30%-55%；P<.001）。Kaplan-Meier 分析表明，全环组的复发性 MR 发生率更高（108 比 103 个月；P=.001）。每组 102 例的风险匹配倾向评分分析（曲线下面积，0.824；95%置信区间，0.788-0.861；P<.001）也表明，与部分环组相比，全环组患者的复发性 MR 发生率更高（7 [7%] 比 17 [17%]；P=.049），Kaplan-Meier 分析也有更大的趋势（110 比 104 个月；P=.068）。
在 FMR 患者中，使用全环成形术环可提高复发性 MR 的自由度。
