From the Department of Cardiac Surgery, IRCCS San Raffaele Scientific Institute, Milan, Italy (M.D.B., E.L., G.L.C., N.B., F.P., M.C., T.N., O.A.); Department of Cardiac Surgery, University Hospital of Zurich, Zurich, Switzerland (F.M.); and Department of Cardiac Surgery, S. Croce Hospital, Cuneo, Italy (F.B.).
Circulation. 2014 Sep 9;130(11 Suppl 1):S19-24. doi: 10.1161/CIRCULATIONAHA.113.007885.
To assess the long-term results of the edge-to-edge mitral repair performed without annuloplasty in degenerative mitral regurgitation (MR).
From 1993 to 2002, 61 patients with degenerative MR were treated with an isolated edge-to-edge suture without any annuloplasty. Annuloplasty was omitted in 36 patients because of heavy annular calcification and in 25 for limited annular dilatation. A double-orifice repair was performed in 53 patients and a commissural edge-to-edge in 8. Hospital mortality was 1.6%. Follow-up was 100% complete (mean length, 9.2±4.21 years; median, 9.7; longest, 18.1). Survival at 12 years was 51.3±7.75%. At the last echocardiographic examination, MR ≥3+ was demonstrated in 33 patients (55%). At 12 years, freedom from reoperation was 57.8±7.21% and freedom from recurrence of MR ≥3+ was 43±7.6%. Residual MR >1+ at hospital discharge was identified as a risk factor for recurrence of MR ≥3+ (hazard ratio, 3.8; 95% confidence interval, 1.7-8.2; P=0.001). In patients with residual MR ≤1+ immediately after surgery, freedom from MR ≥3+ at 5 and 10 years was 80±6% and 64±7.58%, respectively.
In degenerative MR, the overall long-term results of the surgical edge-to-edge technique without annuloplasty are not satisfactory. Early optimal competence (residual MR ≤1+) was associated with higher freedom from recurrent severe regurgitation.
评估在退行性二尖瓣反流（MR）中不进行瓣环成形术进行的边缘到边缘二尖瓣修复的长期结果。
1993 年至 2002 年，对 61 例退行性 MR 患者进行了无瓣环成形术的孤立性边缘到边缘缝合修复。在 36 例患者中，由于瓣环严重钙化而省略了瓣环成形术，在 25 例患者中由于瓣环有限扩张而省略了瓣环成形术。53 例患者行双孔修复，8 例患者行瓣交界边缘对边缘修复。住院死亡率为 1.6%。随访率为 100%（平均长度为 9.2±4.21 年；中位数为 9.7 年；最长为 18.1 年）。12 年生存率为 51.3±7.75%。在最后一次超声心动图检查中，33 例（55%）患者出现 MR≥3+。12 年时，无再手术率为 57.8±7.21%，MR≥3+无复发率为 43±7.6%。出院时存在残余 MR>1+被确定为 MR≥3+复发的危险因素（危险比为 3.8；95%置信区间为 1.7-8.2；P=0.001）。在手术后即刻存在残余 MR≤1+的患者中，5 年和 10 年时无 MR≥3+的生存率分别为 80±6%和 64±7.58%。
在退行性 MR 中，不进行瓣环成形术的外科边缘到边缘技术的总体长期结果并不令人满意。早期出现最佳功能（残余 MR≤1+）与较高的无复发性严重反流相关。
