Kwedar Kathleen, McNeely Christian, Zajarias Alan, Markwell Steve, Vassileva Christina M
Division of Cardiothoracic Surgery, Southern Illinois University School of Medicine, Springfield, Illinois; Department of Medicine, University of Missouri School of Medicine, Columbia, Missouri.
Division of Cardiothoracic Surgery, Southern Illinois University School of Medicine, Springfield, Illinois; Department of Medicine, Washington University School of Medicine, St. Louis, Missouri.
Ann Thorac Surg. 2017 Nov;104(5):1516-1521. doi: 10.1016/j.athoracsur.2017.05.001. Epub 2017 Jul 29.
Surgical series on mitral valve reoperation are limited by small numbers and lack of national representation. Large-scale outcomes of reoperation for mitral valve surgery remain uncertain.
This is a descriptive analysis of 1,627 Medicare beneficiaries who underwent mitral valve reoperation within a 3-year follow-up period after an initial mitral operation (repair or replacement) that took place between 2000 and 2006. The primary outcomes were hospital mortality and long-term survival.
The 1,627 patients included in the study comprise 1.6% of patients who underwent operation between 2000 and 2006. The initial surgery was repair in 49.9%, bioprosthetic replacement in 22.0%, and mechanical replacement in 28.1%. Re-repair was performed in 15.4%. Hospital mortality was 12.0% and was similar for repair and bioprosthetic or mechanical replacement. Reoperative mortality was similar for men and women and for patients aged 75 years or less versus more than 75 years; and was significantly higher for nonelective than for elective operations (15.6% versus 5.5%, p = 0.0001), for patients with endocarditis than without endocarditis (21.4% versus 11.0%, p = 0.0001), and for patients with heart failure than without heart failure (14.2% versus 9.9%, p = 0.0080). Cumulative long-term survival rates were 58.6% at 5 years.
The incidence of mitral valve reoperation within 3 years after initial repair or replacement is low but carries high surgical risk, which is significantly increased by certain preoperative characteristics, such as urgent status, endocarditis, and heart failure.
二尖瓣再次手术的外科手术系列研究因数量少且缺乏全国代表性而受到限制。二尖瓣手术再次手术的大规模结果仍不确定。
这是一项对1627名医疗保险受益人的描述性分析，这些受益人在2000年至2006年首次进行二尖瓣手术（修复或置换）后的3年随访期内接受了二尖瓣再次手术。主要结局是医院死亡率和长期生存率。
纳入研究的1627例患者占2000年至2006年接受手术患者的1.6%。初次手术为修复的占49.9%，生物瓣置换的占22.0%，机械瓣置换的占28.1%。再次修复的占15.4%。医院死亡率为12.0%，修复手术与生物瓣或机械瓣置换手术的死亡率相似。再次手术死亡率在男性和女性之间、75岁及以下与75岁以上患者之间相似；非择期手术的死亡率显著高于择期手术（15.6%对5.5%，p = 0.0001），有感染性心内膜炎的患者高于无感染性心内膜炎的患者（21.4%对11.0%，p = 0.0001），有心力衰竭的患者高于无心力衰竭的患者（14.2%对9.9%，p = 0.0080）。5年累计长期生存率为58.6%。
初次修复或置换后3年内二尖瓣再次手术的发生率较低，但手术风险高，某些术前特征，如紧急状态、感染性心内膜炎和心力衰竭，会显著增加手术风险。
