Bogachev-Prokophiev Alexander, Afanasyev Alexander, Zheleznev Sergey, Fomenko Michael, Sharifulin Ravil, Kretov Eugenie, Karaskov Alexander
Department of Heart Valves Surgery, Siberian Biomedical Research Center, Ministry of Health Russian Federation, Novosibirsk, Russian Federation.
Interact Cardiovasc Thorac Surg. 2017 Sep 1;25(3):356-362. doi: 10.1093/icvts/ivx152.
The optimal surgical strategy for concomitant mitral valve intervention during myectomy remains controversial. The purpose of this study was to compare the results of mitral valve replacement versus repair in patients with hypertrophic obstructive cardiomyopathy and severe mitral regurgitation.
Between 2010 and 2013, a total of 88 patients with hypertrophic obstructive cardiomyopathy and severe mitral regurgitation were randomly assigned to undergo either mitral valve replacement or repair in addition to extended myectomy.
Three patients from the repair group were switched to mitral valve replacement after repair failure. There was 1 early death (2.4%) in the replacement group. The resting left ventricular outflow tract gradient was reduced from 89.1 ± 20.4 to 18.3 ± 5.7 mmHg (P < 0.001) and from 96.6 ± 28.1 to 14.7 ± 5.9 mmHg (P < 0.001) in the replacement and repair groups, respectively; there was no significant difference between the groups (P = 0.458). At 2-year follow-up, overall survival was 87.2 ± 4.9% and 96.7 ± 3.3% (P = 0.034); freedom from sudden cardiac death was 95.6 ± 3.1% and 96.7 ± 3.3% (P = 0.615); and freedom from thromboembolic events was 91.2 ± 4.2% and 100%, respectively (P = 0.026).
Both mitral valve repair and valve replacement in addition to extended myectomy are effective methods of surgical treatment in patients with hypertrophic obstructive cardiomyopathy who have severe mitral regurgitation. The benefits of mitral valve repair are better overall survival and a lower rate of thromboembolic events.
ClinicalTrials.gov: NCT02054221.
在肥厚心肌切除术期间，同期二尖瓣干预的最佳手术策略仍存在争议。本研究的目的是比较肥厚性梗阻性心肌病合并严重二尖瓣反流患者二尖瓣置换术与二尖瓣修复术的结果。
2010年至2013年期间，共有88例肥厚性梗阻性心肌病合并严重二尖瓣反流患者被随机分配接受二尖瓣置换术或修复术，同时进行扩大的肥厚心肌切除术。
修复组有3例患者在修复失败后转为二尖瓣置换术。置换组有1例早期死亡（2.4%）。置换组静息左心室流出道压差从89.1±20.4降至18.3±5.7mmHg（P<0.001），修复组从96.6±28.1降至14.7±5.9mmHg（P<0.001）；两组间无显著差异（P=0.458）。在2年随访时，总生存率分别为87.2±4.9%和96.7±3.3%（P=0.034）；无心脏性猝死生存率分别为95.6±3.1%和96.7±3.3%（P=0.615）；无血栓栓塞事件生存率分别为91.2±4.2%和100%（P=0.026）。
对于合并严重二尖瓣反流的肥厚性梗阻性心肌病患者，二尖瓣修复术和瓣膜置换术联合扩大的肥厚心肌切除术都是有效的手术治疗方法。二尖瓣修复术的益处是总体生存率更高和血栓栓塞事件发生率更低。
ClinicalTrials.gov：NCT02054221。
