Department of Surgery, Keck School of Medicine of USC, University of Southern California, Los Angeles, Calif.
Department of Surgery, Keck School of Medicine of USC, University of Southern California, Los Angeles, Calif.
J Thorac Cardiovasc Surg. 2017 Sep;154(3):822-830.e2. doi: 10.1016/j.jtcvs.2017.01.047. Epub 2017 Feb 9.
To evaluate outcomes after mitral valve repair.
Between May 1999 and June 2015, 446 patients underwent mitral valve repair. Isolated mitral valve annuloplasty was excluded. A total of 398 (89%) had degenerative valve disease. Mean follow-up was 5.5 ± 3.8 years. Postoperative echocardiograms were obtained in 334 patients (75%) at a mean of 24.3 ± 13.7 months.
Survival was 97%, 96%, 95%, and 94% at 1, 3, 5, and 10 years. Risk factor analysis showed age >60 years and nondegenerative etiology predict death (hazard ratio, 2.91; 95% confidence interval, 1.06-8.02, P = .038; and hazard ratio, 1.87; 95% confidence interval, 1.16-3.02, P = .010, respectively). Considering competing risks due to mortality, the cumulative incidence of reoperation was 2.8%, 4.2%, 5.1%, and 9.6% at 1, 3, 5, and 10 years. Competing risk proportional hazard survival regression identified nondegenerative etiology and previous cardiac surgery as predictors of reoperation, and posterior repair was protective (all P < .05). Cumulative incidence of progression of mitral regurgitation (2 or more grades) with mortality as a competing risk was 4.7%, 10.5%, 21.0%, and 35.8% at 1, 3, 5, and 10 years. Patients with previous sternotomy, repair or coronary artery bypass grafting, and concurrent tricuspid valve procedure or isolated anterior leaflet repair were more likely to develop progression of mitral regurgitation (all P < .05), and posterior leaflet repair was protective (P = .038). On multivariate analysis diabetes, previous coronary artery bypass grafting and concurrent tricuspid valve intervention predicted MR progression.
Mitral valve repair has excellent outcomes. Our results demonstrate failures appear to occur less in those who undergo posterior leaflet repair.
评估二尖瓣修复术后的结果。
1999 年 5 月至 2015 年 6 月期间，共有 446 例患者接受了二尖瓣修复术。排除了单纯二尖瓣瓣环成形术。共有 398 例（89%）患有退行性瓣膜病。平均随访时间为 5.5±3.8 年。334 例患者（75%）在平均 24.3±13.7 个月时获得了术后超声心动图。
1、3、5 和 10 年的生存率分别为 97%、96%、95%和 94%。风险因素分析显示，年龄>60 岁和非退行性病因预测死亡（风险比，2.91；95%置信区间，1.06-8.02，P=0.038；和风险比，1.87；95%置信区间，1.16-3.02，P=0.010）。考虑到死亡率引起的竞争风险，1、3、5 和 10 年时的再手术累积发生率分别为 2.8%、4.2%、5.1%和 9.6%。竞争风险比例风险生存回归确定了非退行性病因和先前的心脏手术是再手术的预测因素，而后侧修复是保护性的（均 P<0.05）。以死亡率为竞争风险的二尖瓣反流进展（2 个或更多等级）的累积发生率分别为 1、3、5 和 10 年时的 4.7%、10.5%、21.0%和 35.8%。有先前胸骨切开术、修复或冠状动脉旁路移植术以及同期三尖瓣手术或单纯前叶修复的患者更有可能发生二尖瓣反流进展（均 P<0.05），而后叶修复是保护性的（P=0.038）。多变量分析显示，糖尿病、先前的冠状动脉旁路移植术和同期三尖瓣介入治疗预测了 MR 进展。
二尖瓣修复术具有出色的结果。我们的结果表明，后叶修复的患者发生失败的可能性似乎更小。
