Cardiac Surgery Unit, Department of Cardiac, Thoracic, and Vascular Sciences, University of Padua, Italy.
Cardiac Surgery Unit, Department of Cardiac, Thoracic, and Vascular Sciences, University of Padua, Italy.
Int J Cardiol. 2018 Apr 15;257:230-234. doi: 10.1016/j.ijcard.2018.01.026. Epub 2018 Jan 31.
Our aim is to investigate the acute intraoperative effects of the NeoChord repair procedure on mitral valve (MV) annular geometry and LV function and the impact of these changes on MR at 1-year follow-up.
Recently transapical off-pump mitral valve repair with NeoChord implantation has been demonstrated to be safe and effective in patients with degenerative mitral regurgitation (DMR).
We retrospectively analyzed baseline and early postoperative 3-dimensional transesophageal echocardiography of 66 patients who underwent NeoChord repair for isolated posterior leaflet MV disease using semiautomatic off-line analysis software.
We observed a significant acute reduction of indexed LV end diastolic volume (Δ% = 14, p < .001), LV ejection fraction (Δ = 5.7%, p = .002), indexed left atrial volume (Δ = 14.7%, p = .045), and pulmonary artery pressure (Δ = 2.1%, p = .026). Among MV geometric parameters, we observed a significant reduction of MV antero-posterior diameter (Δ = 7%, p < .001), sphericity index (Δ = 8%, p < .001), annulus circumference (Δ = 0.9%, p = .021), and annulus area (Δ = 2.7%, p = .018). At 1-year, 53 patients (85.5%) presented MR ≤ mild, while 9 patients (14.5%) had MR ≥ moderate. Reduction of AP diameter (OR = 0.14, CI -3.83; 0.08, p < .001), annulus circumference (OR = 0.27, CI -2.98; 0.37, p = .005), MV area (OR = 0.39, CI -2.46; 0.61, p = .04), aorto-mitral angle (OR = 0.38, CI -2.49; 0.54, p = .002) and iEDV (OR = 0.44, CI -2.44; 0.81, p = .001) were independent protective factors against recurrence of MR greater than mild at 1-year follow-up.
Transapical NeoChord repair produces important acute intraoperative changes in MV anatomy in DMR patients. The acute changes observed were associated with procedure durability at 1-year FU.
本研究旨在探讨 NeoChord 修复术对二尖瓣（MV）环几何形状和左心室（LV）功能的急性术中影响，以及这些变化对 1 年随访时二尖瓣反流（MR）的影响。
最近，经心尖非体外循环二尖瓣修复术联合 NeoChord 植入术已被证明在退行性二尖瓣反流（DMR）患者中是安全有效的。
我们回顾性分析了 66 例接受 NeoChord 修复术治疗孤立性后瓣 MV 疾病的患者的基线和术后 3 个月的经食管超声心动图（TEE）。使用半自动离线分析软件对数据进行分析。
我们观察到 LV 舒张末期容积指数（Δ%=14，p<0.001）、LV 射血分数（Δ=5.7%，p=0.002）、左心房容积指数（Δ=14.7%，p=0.045）和肺动脉压（Δ=2.1%，p=0.026）显著降低。在 MV 几何参数方面，我们观察到 MV 前后径（Δ=7%，p<0.001）、球形指数（Δ=8%，p<0.001）、瓣环周长（Δ=0.9%，p=0.021）和瓣环面积（Δ=2.7%，p=0.018）显著减小。在 1 年时，53 例（85.5%）患者 MR 为轻度，9 例（14.5%）患者 MR 为中重度。AP 直径减小（OR=0.14，CI -3.83；0.08，p<0.001）、瓣环周长减小（OR=0.27，CI -2.98；0.37，p=0.005）、MV 面积减小（OR=0.39，CI -2.46；0.61，p=0.04）、主动脉瓣环角度减小（OR=0.38，CI -2.49；0.54，p=0.002）和 iEDV 减小（OR=0.44，CI -2.44；0.81，p=0.001）是 1 年随访时 MR 复发大于轻度的独立保护因素。
经心尖 NeoChord 修复术在 DMR 患者中产生了重要的 MV 解剖学的急性术中变化。观察到的急性变化与 1 年 FU 时的手术耐久性有关。
