De Bonis Michele, Lapenna Elisabetta, Taramasso Maurizio, La Canna Giovanni, Buzzatti Nicola, Pappalardo Federico, Alfieri Ottavio
Department of Cardiac Surgery, San Raffaele Scientific Institute, Milan, Italy.
Department of Cardiac Surgery, San Raffaele Scientific Institute, Milan, Italy.
J Thorac Cardiovasc Surg. 2014 Nov;148(5):2027-32. doi: 10.1016/j.jtcvs.2014.03.041. Epub 2014 Mar 27.
To assess the very long-term clinical and echocardiographic results of the edge-to-edge repair for mitral regurgitation (MR) due to isolated prolapse or flail of the anterior leaflet.
From 1991 to 2004, 139 patients (age, 54±14.4 years; left ventricular ejection fraction 56%±7.8%, New York Heart Association class I-II in 68.9%, atrial fibrillation in 20.1%) with severe degenerative MR due to isolated segmental prolapse or flail of the anterior leaflet were treated with the EE technique combined with annuloplasty. MR had resulted from prolapse or flail of the central scallop of the anterior leaflet (A2) in 105 patients (75.5%) and scallops A1 or A3 in 34 (24.4%).
No hospital deaths occurred. At hospital discharge, MR was absent or mild in 130 patients (93.5%) and moderate (2+/4+) in 9 (6.4%). The clinical and echocardiographic follow-up data were 97.1% complete (mean length, 11.5±3.73 years; median, 11; longest duration, 21.5). At 17 years, the actuarial survival was 72.4%±7.89%, freedom from cardiac death was 90.8%±4.77%, and freedom from reoperation was 89.6%±2.74%. At the last echocardiographic examination, recurrence of MR grade≥3+ was documented in 17 patients (17 of 135, 12.5%). Freedom from MR grade≥3+ at 17 years was 80.2%±5.86%. At multivariate analysis, the predictors of MR recurrence grade≥3+ were residual MR greater than mild at hospital discharge (hazard ratio, 7.4; 95% confidence interval, 2.5-21.2; P=.0001) and the use of posterior pericardial rather than prosthetic ring annuloplasty, which was very close to statistical significance (hazard ratio, 2.8; 95% confidence interval, 0.9-8.7; P=.06).
In patients with MR due to segmental anterior leaflet prolapse, the very long-term results of the edge-to-edge repair combined with annuloplasty were excellent.
评估因孤立性前叶脱垂或连枷样病变导致的二尖瓣反流（MR）行缘对缘修复术的极长期临床和超声心动图结果。
1991年至2004年，139例因孤立性节段性前叶脱垂或连枷样病变导致严重退行性MR的患者（年龄54±14.4岁；左心室射血分数56%±7.8%，纽约心脏协会心功能分级I-II级者占68.9%，心房颤动者占20.1%）接受了缘对缘技术联合瓣环成形术治疗。105例（75.5%）患者的MR由前叶中央扇贝形结构（A2）脱垂或连枷样病变引起，34例（24.4%）由A1或A3扇贝形结构病变引起。
无住院死亡病例。出院时，130例患者（93.5%）的MR消失或轻微，9例（6.4%）为中度（2+/4+）。临床和超声心动图随访数据的完整性为97.1%（平均时长11.5±3.73年；中位数11年；最长时长21.5年）。17年时，精算生存率为72.4%±7.89%，无心脏死亡生存率为90.8%±4.77%，无需再次手术生存率为89.6%±2.74%。在最后一次超声心动图检查时，17例患者（135例中的17例，12.5%）记录到MR复发≥3+级。17年时无MR≥3+级的生存率为80.2%±5.86%。多因素分析显示，MR复发≥3+级的预测因素为出院时残留MR大于轻度（风险比7.4；95%置信区间2.5-21.2；P = 0.0001）以及使用后心包瓣环成形术而非人工瓣环成形术，后者接近具有统计学意义（风险比2.8；95%置信区间0.9-8.7；P = 0.06）。
对于因节段性前叶脱垂导致MR的患者，缘对缘修复联合瓣环成形术的极长期结果极佳。
