Department of Cardiothoracic Surgery, Leiden University Medical Centre, Leiden, The Netherlands.
Department of Cardiology, Leiden University Medical Centre, Leiden, The Netherlands.
J Cardiol. 2018 Dec;72(6):473-479. doi: 10.1016/j.jjcc.2018.04.016. Epub 2018 May 31.
In asymptomatic patients with severe degenerative mitral valve regurgitation (MR), early surgery is often performed in experienced centers. The patient- and valve-related results and the quality of life after surgery in these patients remain insufficiently explored.
Between 1/2000 and 12/2015, 83 asymptomatic patients (mean age 56.6±12.6 years, 21 female) without any complications related to long-lasting MR underwent early surgery. Follow-up clinical and echocardiographic data and health-related quality of life assessment (SF-36) were studied and matched to the general population.
Repair rate was 100% and early mortality was 0%. Residual MR (≥grade 2+) was seen in 1 (1%) patient who underwent a successful re-repair while 4 (5%) patients needed permanent pacemaker implantation. At a median follow-up of 7.6 (IQR 4.1-11.9) years, 6 late deaths occurred. The 10-year overall survival rate was 91.5% (95% CI 84.2-98.8%) and was comparable to the general population. The health-related quality of life (84% complete) did not differ from the general population. One patient underwent late reintervention. Median echocardiography follow-up was 5.2 years (IQR 2.4-10.4; 98% complete). The 10-year freedom from recurrent MR rate (≥grade 2+) was 86.7% (95% CI 76.1-97.3%). The 10-year freedom from any atrial tachycardia rate was 68.7% (95% CI 55.2-82.2%) while 7 (8%) patients underwent late pacemaker implantation.
Early surgical intervention in asymptomatic patients with severe MR can be performed safely and restores normal life expectancy and quality of life. However, the frequency of late arrhythmias and pacemaker implantation is high and needs further evaluation.
在无症状的重度退行性二尖瓣反流（MR）患者中，经验丰富的中心通常会进行早期手术。这些患者的患者和瓣膜相关结果以及手术后的生活质量仍未得到充分探讨。
在 2000 年 1 月至 2015 年 12 月期间，83 名无症状患者（平均年龄 56.6±12.6 岁，21 名女性）无任何与长期 MR 相关的并发症，接受了早期手术。研究了随访的临床和超声心动图数据以及与健康相关的生活质量评估（SF-36），并与一般人群进行了匹配。
修复率为 100%，早期死亡率为 0%。1 名（1%）患者出现残余 MR（≥2 级），成功进行了再次修复，而 4 名（5%）患者需要植入永久性起搏器。中位随访 7.6 年（IQR 4.1-11.9）时，发生 6 例晚期死亡。10 年总生存率为 91.5%（95%CI 84.2-98.8%），与一般人群相当。健康相关的生活质量（84%完整）与一般人群无差异。1 名患者进行了晚期再次介入治疗。中位超声心动图随访时间为 5.2 年（IQR 2.4-10.4；98%完整）。10 年无复发性 MR（≥2 级）的生存率为 86.7%（95%CI 76.1-97.3%）。10 年无任何房性心动过速的生存率为 68.7%（95%CI 55.2-82.2%），而 7 名（8%）患者进行了晚期起搏器植入。
无症状的重度 MR 患者进行早期手术干预是安全的，可以恢复正常的预期寿命和生活质量。然而，晚期心律失常和起搏器植入的频率较高，需要进一步评估。
