Anyanwu Anelechi C, Itagaki Shinobu, Chikwe Joanna, El-Eshmawi Ahmed, Adams David H
Department of Cardiovascular Surgery, Icahn School of Medicine at Mount Sinai, New York, NY.
Department of Cardiovascular Surgery, Icahn School of Medicine at Mount Sinai, New York, NY.
J Thorac Cardiovasc Surg. 2016 Jun;151(6):1661-70. doi: 10.1016/j.jtcvs.2016.01.033. Epub 2016 Jan 22.
To develop a score to allow stratification of complexity in degenerative mitral valve repair.
Retrospective modeling of data from 668 consecutive patients who underwent surgery for mitral valve prolapse. A complexity scoring scale was developed using a consensus approach, assigning a score to each valve, based on the following: prolapsing segments (weight 1 for each posterior segment; weight 2 for each anterior or commissural segment); presence of valve restriction (weight 2); presence of calcification (weight 3 if annulus involved, otherwise weight 2); and prior mitral valve repair (weight 3). Valve repairs were categorized into 3 groups based on the complexity score: 1: Simple (n = 244); 2-4: Intermediate (n = 260); ≥5: Complex (n = 164).
Mitral valve repair was successfully performed in 667 patients (repair rate: 99.9%). The complexity score was directly correlated with surrogates of technical complexity. The mean cardiopulmonary bypass time increased with lesion complexity ([in minutes] simple: 152; intermediate: 167; complex 195; P < .001). The median number of repair techniques utilized was related to lesion complexity (simple: 3; intermediate: 4; complex: 5; P < .001). Barlow's type etiology was more prevalent in complex cases (63%), compared with simple (9%) and intermediate (35%) cases (P < .001). Advanced repair techniques were required to complete repair in 51% of complex cases, compared with 14% of intermediate and 0% of simple cases (P < .001). Early and late outcomes were similar.
Our scoring system may allow effective stratification of complexity of mitral valve repair. Future studies are required to evaluate the use of our score in a prospective setting.
制定一个评分系统，用于对退行性二尖瓣修复的复杂性进行分层。
对668例连续接受二尖瓣脱垂手术患者的数据进行回顾性建模。采用共识法制定复杂性评分量表，根据以下因素为每个瓣膜打分：脱垂节段（每个后叶节段权重为１；每个前叶或交界节段权重为２）；瓣膜受限情况（权重为２）；钙化情况（若瓣环受累权重为３，否则权重为２）；既往二尖瓣修复史（权重为３）。根据复杂性评分将瓣膜修复分为３组：1：简单（n = 244）；2 - 4：中等（n = 260）；≥5：复杂（n = 164）。
667例患者成功进行了二尖瓣修复（修复率：99.９％）。复杂性评分与技术复杂性指标直接相关。体外循环时间均值随病变复杂性增加而延长（[分钟]简单：152；中等：167；复杂：195；P <.001）。所采用修复技术的中位数与病变复杂性相关（简单：3；中等：4；复杂：5；P <.001）。复杂病例中Barlow型病因更为常见（63％），而简单病例（9％）和中等病例（35％）中较少见（P <.001）。51％的复杂病例需要采用高级修复技术才能完成修复，而中等病例为14％，简单病例为0％（P <.001）。早期和晚期结果相似。
我们的评分系统可能有助于对二尖瓣修复的复杂性进行有效分层。未来需要进行研究，以评估我们的评分在前瞻性研究中的应用。
