Division of Cardiac Surgery, University of Verona, Verona, Italy.
Department of Cardiac Surgery, Leicester University Hospital, Leicester, UK.
J Cardiothorac Vasc Anesth. 2018 Apr;32(2):646-653. doi: 10.1053/j.jvca.2017.09.039. Epub 2017 Sep 28.
Transcatheter mitral valve-in-valve/valve-in-ring procedures (TM-VIVoR) are increasing. The authors aimed to identify independent predictors for hospital mortality in redo mitral valve surgery as possible future selection criteria for TM-VIVoR.
Retrospective multicenter registry.
Tertiary university and community hospitals.
Two-hundred and sixty patients (out of 920 enrolled) who are potentially candidates for TM-VIVoR undergoing redo-surgery.
Redo mitral surgery.
Regression analyzes and receiver operating characteristic (ROC) curves identified independent predictors of death. Patients potentially candidates for TM-VIVoR reported significant hospital mortality (9.2%; EuroSCORE II: 13.2 ± 13.1, Society of Thoracic Surgeons [STS] score: 6.2 ± 3.1) and major morbidity (3.8% acute myocardial infarction, 5% stroke, 16.9% perioperative respiratory failure, 16.5% acute renal insufficiency, 25% massive transfusions). EuroSCORE II (odds ration [OR] 1.06; confidence interval [CI] 1.01-1.10; p = 0.005), STS score (OR 1.58; CI 1.27-1.97; p = 0.001), age at surgery (OR 1.05; CI 1.00-1.15; p = 0.05), preoperative dialysis (OR 2.5; CI 1.8-12.6; p = 0.042), left ventricular ejection fraction (LVEF) <30% (OR 4.8; CI 1.12-37.1; p = 0.021), severe pulmonary hypertension (OR 7.5; CI 1.9-29.4; p = 0.003), and previous coronary artery bypass grafting (CABG) (OR 11.8; CI 1.7-36.9; p = 0.002) were independent predictors of hospital mortality. ROC analyses reported good prediction for EuroSCORE II (AUC: 0.76; cut-off value: >13.1; 70.8% sensitivity and 68.2% specificity) and better prediction for STS score (AUC: 0.81; cut-off value: 7.4; 75.0% sensitivity and 66.2% specificity). Quintiles stratification identified EuroSCORE II ≥18.7 (5th quintile, observed mortality: 19.3%) and STS score >9.1 as strong predictors of death within each risk-categorization (OR 5.9 and 12.1, respectively).
High EuroSCORE II and STS scores, advanced age at surgery, LVEF <30%, previous CABG, severe pulmonary hypertension or preoperative dialysis might represent in the future preferred indications for TM-VIVoR in the redo-mitral surgery scenario.
经导管二尖瓣瓣中瓣/瓣上环（TM-VIVoR）手术的数量不断增加。作者旨在确定二尖瓣再次手术中与医院死亡率相关的独立预测因素，以便为 TM-VIVoR 未来的选择标准提供参考。
回顾性多中心注册研究。
三级大学和社区医院。
260 名（920 名入选患者中的）可能适合 TM-VIVoR 并接受二尖瓣再次手术的患者。
二尖瓣再次手术。
回归分析和受试者工作特征（ROC）曲线确定了死亡的独立预测因素。可能适合 TM-VIVoR 的患者报告了显著的医院死亡率（9.2%；欧洲心脏手术风险评估系统 II 评分：13.2 ± 13.1，胸外科医师学会评分：6.2 ± 3.1）和主要并发症（3.8%急性心肌梗死，5%中风，16.9%围手术期呼吸衰竭，16.5%急性肾功能不全，25%大量输血）。欧洲心脏手术风险评估系统 II 评分（比值比 [OR] 1.06；置信区间 [CI] 1.01-1.10；p = 0.005）、胸外科医师学会评分（OR 1.58；CI 1.27-1.97；p = 0.001）、手术时的年龄（OR 1.05；CI 1.00-1.15；p = 0.05）、术前透析（OR 2.5；CI 1.8-12.6；p = 0.042）、左心室射血分数（LVEF）<30%（OR 4.8；CI 1.12-37.1；p = 0.021）、严重肺动脉高压（OR 7.5；CI 1.9-29.4；p = 0.003）和既往冠状动脉旁路移植术（CABG）（OR 11.8；CI 1.7-36.9；p = 0.002）是医院死亡率的独立预测因素。ROC 分析报告了欧洲心脏手术风险评估系统 II 的良好预测（AUC：0.76；临界值：>13.1；70.8%的敏感性和 68.2%的特异性）和胸外科医师学会评分的更好预测（AUC：0.81；临界值：7.4；75.0%的敏感性和 66.2%的特异性）。五分位分层确定欧洲心脏手术风险评估系统 II ≥18.7（第 5 分位数，观察死亡率：19.3%）和胸外科医师学会评分>9.1 是每个风险分类内死亡的强预测因素（OR 5.9 和 12.1）。
高欧洲心脏手术风险评估系统 II 和胸外科医师学会评分、手术时年龄较大、LVEF<30%、既往 CABG、严重肺动脉高压或术前透析可能是二尖瓣再次手术中 TM-VIVoR 的未来首选适应证。
