State Key Laboratory of Cardiovascular Disease, Department of Adult Cardiac Surgery, Fuwai Hospital,National Center for Cardiovascular Disease, Chinese Academy of Medical Science, Peking Union Medical College, Beijing, China.
Sci Rep. 2018 Jan 24;8(1):1537. doi: 10.1038/s41598-018-19909-7.
Although practice guidelines recommend surgery for patients with severe chronic ischemic mitral regurgitation (CIMR), they do not specify whether to repair or replace the mitral valve. 436 consecutive patients with severe CIMR were eligible for inclusion in the study, of which 316 (72.5%) underwent mitral valve annuloplasty (MVA) whereas 120 (27.5%) received mitral valve replacement (MVR). At 59 months (interquartile range, 37-85 months) follow-up, though the left ventricle end-diastolic diameter was markedly larger (P = 0.019) in the MVA group than in the MVR group, no significant difference was observed in overall survival, freedom from cardiac death, or avoidance of major adverse cardiac or cerebrovascular events (MACCE). MVA provides better results in freedom from cardiac death in subgroups of age ≥65years and left ventricular ejection fraction (EF) ≥50% (P = 0.014 and P = 0.016, respectively), whereas MVR was associated with a lower risk of MACCE in subgroups of age <65years, EF <50% and left ventricular inferior basal wall motion abnormality (BWMA) (all P < 0.05). In conclusion, MVR is a suitable management of patients with severe CIMR, and it is more favorable to ventricular remodeling. The choice of MVA or MVR should depend on major high-risk clinical factors.
尽管实践指南建议对严重慢性缺血性二尖瓣反流（CIMR）患者进行手术，但并未具体说明是修复还是置换二尖瓣。符合研究条件的严重 CIMR 患者共 436 例，其中 316 例（72.5%）接受了二尖瓣环成形术（MVA），120 例（27.5%）接受了二尖瓣置换术（MVR）。在 59 个月（四分位间距，37-85 个月）的随访中，尽管 MVA 组的左心室舒张末期直径明显大于 MVR 组（P=0.019），但两组的总生存率、无心脏死亡生存率或避免主要不良心脏或脑血管事件（MACCE）生存率无显著差异。MVA 在年龄≥65 岁和左心室射血分数（EF）≥50%的亚组中，在无心脏死亡生存率方面提供了更好的结果（P=0.014 和 P=0.016），而 MVR 在年龄<65 岁、EF<50%和左心室下基底壁运动异常（BWMA）的亚组中与 MACCE 风险较低相关（均 P<0.05）。总之，MVR 是严重 CIMR 患者的一种合适的治疗方法，有利于心室重构。MVA 或 MVR 的选择应取决于主要的高危临床因素。
