Chan Vincent, Elmistekawy Elsayed, Ruel Marc, Hynes Mark, Mesana Thierry G
Division of Cardiac Surgery, University of Ottawa, Ottawa, Ontario, Canada; School of Epidemiology, Public Health and Preventive Medicine, University of Ottawa, Ottawa, Ontario, Canada.
Division of Cardiac Surgery, University of Ottawa, Ottawa, Ontario, Canada.
Ann Thorac Surg. 2016 Nov;102(5):1459-1465. doi: 10.1016/j.athoracsur.2016.08.088. Epub 2016 Oct 6.
Repair of mitral regurgitation (MR) caused by prolapse has been well validated. Although favorable early and late results after repair have been reported, few data are available that mechanistically describe how a mitral repair fails beyond the mere need for mitral valve reoperation. We therefore sought to determine the modes of valve repair failure in patients who underwent surgical correction of MR caused by prolapse.
Between 2001 and 2015, 855 patients underwent repair of MR caused by prolapse. Patients were a mean age of 63.7 ± 12.7 years, and 380 (44%) had bileaflet prolapse. The overall repair rate was 97.2%. These patients were monitored as part of a cohort initiative and underwent serial clinical and echocardiographic assessments at 1, 3 to 6, and 12 months after the operation. Beyond the first year of the MR repair, patients were assessed by echocardiography every 1 to 2 years or when clinically indicated. Clinical and echocardiographic follow-up averaged 4.3 ± 3.5 years.
Freedom from recurrent MR of 2+ or higher was 92.4% ± 1.3% at 5 years and 86.6% ± 2.4% at 10 years. Overall, recurrent MR of 2+ or higher developed in 49 patients (5.7%) at a mean of 3.1 ± 2.5 years after the repair, of whom 14 (1.6%) had recurrent MR of 3+ or 4+. Among patients with bileaflet prolapse, recurrent MR of 2+ or higher was observed in 24, of whom 9 had 3+ or 4+ MR., The development of recurrent MR of 2+ or higher was categorized as prolapse in 6 and nonprolapse in 43. Severe mitral stenosis occurred in 3 patients at 8.2 years after the MR repair. Mitral reoperation was ultimately performed in 21 patients. Patients who had recurrent MR 2+ or higher within the first year after the operation were more likely to undergo a subsequent mitral valve reoperation (incident rate ratio, 5.2 ± 2.9; p = 0.003), although no association between recurrent MR and reoperation was observed after the first year.
Severe MR after repair is rare, although some may have recurrent moderate MR. Patients who required a subsequent mitral valve reoperation were most likely to have recurrent MR of 2+ or higher within the first year after the operation.
二尖瓣脱垂所致二尖瓣反流（MR）的修复已得到充分验证。尽管已有报道称修复术后早期和晚期效果良好，但关于二尖瓣修复失败的机制性数据却很少，现有数据仅表明二尖瓣修复失败只是需要再次进行二尖瓣手术。因此，我们试图确定接受手术矫正二尖瓣脱垂所致MR患者的瓣膜修复失败模式。
2001年至2015年期间，855例患者接受了二尖瓣脱垂所致MR的修复。患者平均年龄为63.7±12.7岁，380例（44%）为双叶脱垂。总体修复率为97.2%。这些患者作为队列研究的一部分接受监测，并在术后1个月、3至6个月和12个月接受系列临床和超声心动图评估。在MR修复术后第1年之后，患者每1至2年或根据临床指征接受超声心动图评估。临床和超声心动图随访平均为4.3±3.5年。
5年时2+级或更高程度的复发性MR的无复发生存率为92.4%±1.3%，10年时为86.6%±2.4%。总体而言，49例患者（5.7%）在修复术后平均3.1±2.5年出现2+级或更高程度的复发性MR，其中14例（1.6%）出现3+级或4+级复发性MR。在双叶脱垂患者中，24例出现2+级或更高程度的复发性MR，其中9例出现3+级或4+级MR。2+级或更高程度复发性MR的发生被归类为6例脱垂和43例非脱垂。3例患者在MR修复术后8.2年出现严重二尖瓣狭窄。最终21例患者接受了二尖瓣再次手术。术后第1年内出现2+级或更高程度复发性MR的患者更有可能接受后续二尖瓣再次手术（发生率比，5.2±2.9；p = 0.003），尽管在第1年之后未观察到复发性MR与再次手术之间的关联。
修复术后严重MR很少见，尽管有些患者可能会出现复发性中度MR。需要接受后续二尖瓣再次手术的患者最有可能在术后第1年内出现2+级或更高程度的复发性MR。
