Castelvecchio Serenella, Parolari Alessandro, Garatti Andrea, Gagliardotto Piervincenzo, Mossuto Eugenio, Canziani Alberto, Menicanti Lorenzo
Department of Cardiac Surgery, I.R.C.C.S., Policlinico San Donato, Milan, Italy
Department of Cardiac Surgery, I.R.C.C.S., Policlinico San Donato, Milan, Italy Department of Biomedical Science, University of Milan, Milan, Italy.
Eur J Cardiothorac Surg. 2016 Apr;49(4):e72-8; discussion e78-9. doi: 10.1093/ejcts/ezv478. Epub 2016 Jan 27.
To assess the early and mid-term outcomes and related predictors in a consecutive series of patients who underwent surgical ventricular restoration (SVR) combined with additional mitral valve (MV) repair.
From January 2001 to October 2014, 626 patients underwent SVR; of these, 175 (28%, median age 65) had an additional MV repair. Anterior, inferior or diffuse remodelling was present in 124 (71%), 41 (23%) and 10 (6%) patients, respectively. The median ejection fraction was 30%, whereas mitral regurgitation grade was 3.3 ± 0.8. Multivariable logistic regression and Cox regression analyses were used to identify predictors of early and mid-term mortality.
Operative death occurred in 25 patients (14.3%). Independent predictors of early mortality were age, creatinine and ejection fraction score [odds ratio (OR) = 5.1, 95% confidence interval (CI) 2.5-10.3], previous stroke (OR = 8.0, 95% CI 1.5-44), unstable angina (OR = 8.8, 95% CI 1.5-53) and diffuse remodelling (OR = 5.8, 95% CI 1.02-33). Average follow-up was 42 ± 37 months. The actuarial survival rate of the whole patient population at 3, 5 and 8 years was 72 ± 4, 65 ± 4 and 45 ± 6%, respectively. Risk factors for late mortality were preoperative creatinine (OR = 2.6, 95% CI 1.5-4.4), previous implantation of cardioverter defibrillator (OR = 4.7, 95% CI 1.6-5.8), whereas the absence of angina at the time of surgery emerged as protective factor (OR = 0.46, 95% CI 0.23-0.89).
MV repair combined with SVR is a complex and challenging procedure that can be performed with acceptable early and mid-term results. Interestingly, angina features predict both early and late outcome, with unstable angina at the time of surgery being a predictor of poor early outcome and the absence of angina at surgery, a predictor of favourable outcome at mid-term follow-up.
评估接受手术性心室修复（SVR）联合二尖瓣（MV）修复的连续系列患者的早期和中期结局及相关预测因素。
2001年1月至2014年10月，626例患者接受了SVR；其中，175例（28%，中位年龄65岁）还接受了MV修复。分别有124例（71%）、41例（23%）和10例（6%）患者存在前壁、下壁或弥漫性重塑。中位射血分数为30%，而二尖瓣反流分级为3.3±0.8。采用多变量逻辑回归和Cox回归分析来确定早期和中期死亡率的预测因素。
25例患者（14.3%）发生手术死亡。早期死亡的独立预测因素为年龄、肌酐和射血分数评分[比值比（OR）=5.1，95%置信区间（CI）2.5 - 10.3]、既往卒中（OR = 8.0，95% CI 1.5 - 44）、不稳定型心绞痛（OR = 8.8，95% CI 1.5 - 53）和弥漫性重塑（OR = 5.8，95% CI 1.02 - 33）。平均随访时间为42±37个月。整个患者群体在3年、5年和8年的精算生存率分别为72±4%、65±4%和45±6%。晚期死亡的危险因素为术前肌酐（OR = 2.6，95% CI 1.5 - 4.4）、既往植入心脏复律除颤器（OR = 4.7，95% CI 1.6 - 5.8），而手术时无心绞痛则为保护因素（OR = 0.46，95% CI 0.23 - 0.89）。
MV修复联合SVR是一项复杂且具有挑战性的手术，可取得可接受的早期和中期结果。有趣的是，心绞痛特征可预测早期和晚期结局，手术时的不稳定型心绞痛是早期不良结局的预测因素，而手术时无心绞痛则是中期随访良好结局的预测因素。
