Fukunaga Naoto, Miyakoshi Chisato, Sakata Ryuzo, Koyama Tadaaki
Department of Cardiovascular Surgery, Clinical Research Center, Kobe City Medical Center General Hospital, Chuo-ku, Kobe, Japan.
Interact Cardiovasc Thorac Surg. 2018 Sep 1;27(3):322-327. doi: 10.1093/icvts/ivy109.
Little data are available with regard to valve selections in redo valvular surgery. We investigated the impact of valve types on late outcomes after redo mitral valve replacement (MVR).
We retrospectively reviewed 66 patients aged 50-69 (mean age 62.2 ± 5.1) years who underwent redo MVR over the past 25 years. In redo MVR, 46 (69.7%) redo procedures were the 1st redo valvular surgeries, 16 (24.2%) were 2nd redos, 3 (4.5%) were 3rd redos and 1 was a 4th (1.5%) redo. We classified 66 patients into 2 groups: mechanical MVR group (M-MVR, n = 44) and biological MVR group (B-MVR, n = 22). The mean follow-up period was 8.2 ± 6.3 years.
Hospital mortality rates were 3.3% in M-MVR and 9.7% in B-MVR (P = 0.3328). Survival rates in M-MVR and B-MVR at 5 and 10 years were 93.0 ± 4.8% vs 76.0 ± 10.5% and 77.6 ± 9.1% vs 51.3 ± 13.7%, respectively (log-rank test, P = 0.0072). Late death occurred in 7 patients in M-MVR and 9 in B-MVR. Freedom rates from valve-related events in M-MVR and B-MVR at 5 and 10 years were 100.0 ± 0.0% vs 76.5 ± 10.3% and 93.3 ± 6.4% vs 52.4 ± 13.6%, respectively (log-rank test, P < 0.0001). No bleeding and thromboembolic events were observed in M-MVR, whereas gastrointestinal bleeding (n = 1), subarachnoid haemorrhage (n = 1) and cerebral infarction (n = 2) were observed in B-MVR. A predictor of late death was a biological valve in redo MVR (P = 0.0206, hazard ratio = 3.402, 95% confidence interval 1.207-9.591).
It would seem that redo MVR using a mechanical valve was associated with better early and late outcomes in this age group.
关于再次心脏瓣膜手术中的瓣膜选择，可用数据较少。我们研究了瓣膜类型对再次二尖瓣置换术（MVR）后晚期结局的影响。
我们回顾性分析了过去25年中66例年龄在50 - 69岁（平均年龄62.2±5.1岁）接受再次MVR的患者。在再次MVR中，46例（69.7%）再次手术是首次再次心脏瓣膜手术，16例（24.2%）是第二次再次手术，3例（4.5%）是第三次再次手术，1例（1.5%）是第四次再次手术。我们将66例患者分为两组：机械瓣MVR组（M - MVR，n = 44）和生物瓣MVR组（B - MVR，n = 22）。平均随访时间为8.2±6.3年。
M - MVR组的医院死亡率为3.3%，B - MVR组为9.7%（P = 0.3328）。M - MVR组和B - MVR组在5年和10年时的生存率分别为93.0±4.8%对76.0±10.5%以及77.6±9.1%对51.3±13.7%（对数秩检验，P = 0.0072）。M - MVR组有7例发生晚期死亡，B - MVR组有9例。M - MVR组和B - MVR组在5年和10年时与瓣膜相关事件的无事件生存率分别为100.0±0.0%对76.5±10.3%以及93.3±6.4%对52.4±13.6%（对数秩检验，P < 0.0001）。M - MVR组未观察到出血和血栓栓塞事件，而B - MVR组观察到胃肠道出血（n = 1）、蛛网膜下腔出血（n = 1）和脑梗死（n = 2）。再次MVR中生物瓣膜是晚期死亡的一个预测因素（P = 0.0206，风险比 = 3.402，95%置信区间1.207 - 9.591）。
在这个年龄组中，使用机械瓣膜进行再次MVR似乎与更好的早期和晚期结局相关。
