Rezahosseini Omid, Rezaei Mohamadreza, Ahmadi Tafti Seyed Hossein, Jalali Arash, Bina Payvand, Ghiasi Atefeh, Karimi Abbasali, Abbasi Kiomars, Shirzad Mahmood, Davoodi Saeed, Salehi Omran Abbas
Tehran Heart Center, Tehran University of Medical Sciences, Tehran, Iran.
J Tehran Heart Cent. 2015 Oct 27;10(4):188-93.
Many patients with mitral valve diseases need surgical procedures for the repair or replacement of their mitral valve. There is a great deal of controversy over the outcomes of the transseptal (TS) and left atrial (LA) approaches to the mitral valve. We sought to evaluate the outcomes of each approach more accurately by eliminating the possible biases in case selection and matching.
This retrospective study included patients who had surgery for mitral valve diseases via either the TS approach or the LA approach between 2004 and 2011 in Tehran Heart Center. Patients with surgical approaches other than the TS and LA were excluded. To control for the confounding effects, a propensity score matching technique was applied and the patients were matched for 14 demographic and preoperative variables. After the selection of controls, the effect of the TS approach (163 patients) versus the LA approach (652 patients) on the outcomes was presented through odds ratio (OR) with 95% confidence intervals (CI).
The mean age of the patients was 53.15 ± 12.02 years in the TS group and 52.93 ± 13.56 years in the LA group. Females comprised 119 (73.0%) patients in the TS group and 462 (70.9%) in the LA group. There was a significant association in the prevalence of new postoperative atrial fibrillation in the two groups (OR = 1.539, 95%CI: 1.072-2.210; p value = 0.019). Temporary pacemaker placement had no statistically significant difference between the two groups (p value = 0.418). The TS patients had significantly longer pump (p value < 0.001) and cross-clamp (p value < 0.001) times. The mortality rate was 4.1% (27 patients) in the LA group and 6.1% (10 patients) in the TS group (p value = 0.274).
In our study population, the TS approach was associated with higher pump and cross-clamp times as well as risk of postoperative atrial fibrillation, but it did not increase the rates of permanent pacemaker placement, re-operations, and mortality.
许多二尖瓣疾病患者需要进行二尖瓣修复或置换的外科手术。经房间隔（TS）和左心房（LA）入路治疗二尖瓣的疗效存在很大争议。我们试图通过消除病例选择和匹配中可能存在的偏差，更准确地评估每种入路的疗效。
这项回顾性研究纳入了2004年至2011年期间在德黑兰心脏中心通过TS入路或LA入路进行二尖瓣疾病手术的患者。排除采用TS和LA以外手术入路的患者。为控制混杂效应，应用倾向评分匹配技术，对患者的14个人口统计学和术前变量进行匹配。选择对照后，通过比值比（OR）及95%置信区间（CI）呈现TS入路（163例患者）与LA入路（652例患者）对疗效的影响。
TS组患者的平均年龄为53.15±12.02岁，LA组为52.93±13.56岁。TS组女性患者有119例（73.0%），LA组有462例（70.9%）。两组术后新发房颤的患病率存在显著关联（OR = 1.539，95%CI：1.072 - 2.210；p值 = 0.019）。两组间临时起搏器置入无统计学显著差异（p值 = 0.418）。TS组患者的体外循环时间（p值 < 0.001）和主动脉阻断时间（p值 < 0.001）显著更长。LA组的死亡率为4.1%（27例患者），TS组为6.1%（10例患者）（p值 = 0.274）。
在我们的研究人群中，TS入路与更长的体外循环和主动脉阻断时间以及术后房颤风险相关，但并未增加永久起搏器置入、再次手术和死亡率。
