Department of Cardiac Surgery and Shanghai Institute of Cardiovascular Diseases, Zhongshan Hospital, Fudan University, Shanghai, China.
Department of Cardiac Surgery and Shanghai Institute of Cardiovascular Diseases, Zhongshan Hospital, Fudan University, Shanghai, China.
Ann Thorac Surg. 2018 Oct;106(4):1063-1070. doi: 10.1016/j.athoracsur.2018.05.011. Epub 2018 Jun 5.
This study aimed to evaluate the clinical trends of mitral valve repair for degenerative mitral regurgitation and the benefit of early surgical intervention on repair durability in a high-volume center.
From January 2003 to December 2015, 1,903 consecutive patients with severe degenerative mitral regurgitation underwent mitral valve repair at our institution. The timing of surgical intervention was evaluated by guideline-related indications including symptoms, atrial fibrillation, left ventricular dysfunction, and pulmonary hypertension. Clinical outcomes and risk factors for recurrent mitral regurgitation were analyzed.
Over 13 years from 2003 to 2015, trends of preoperative characteristics demonstrated that the proportion of asymptomatic patients substantially increased. The 8-year overall survival, freedom from reoperation for mitral valve, and freedom from recurrent mitral regurgitation were 96%, 96%, and 85%, respectively. Ejection fraction less than 60%, left ventricular end-diastolic dimension greater than 60 mm, isolated anterior leaflet lesion, and intraoperative mild residual mitral regurgitation were independent predictive factors for recurrent mitral regurgitation. The incidence of recurrent mitral regurgitation was significantly lower in the early intervention group (3% versus 18%, p < 0.01). In subgroup analysis of asymptomatic patients, the incidence of recurrent mitral regurgitation was significantly lower in patients without guideline-related indications (3% versus 31%, p < 0.0001).
Early surgical intervention for severe degenerative mitral regurgitation before symptoms, atrial fibrillation, and ventricular dysfunction are associated with excellent clinical outcomes. Besides complexity of leaflet lesion and repair quality, surgical timing also significantly affects repair durability. Early surgical intervention should therefore be recommended to reduce recurrent mitral regurgitation.
本研究旨在评估退行性二尖瓣关闭不全患者行二尖瓣修复术的临床趋势，以及在高容量中心早期手术干预对修复耐久性的益处。
从 2003 年 1 月至 2015 年 12 月，我院对 1903 例严重退行性二尖瓣关闭不全患者行二尖瓣修复术。手术干预时机根据指南相关适应证进行评估，包括症状、心房颤动、左心室功能障碍和肺动脉高压。分析临床结果和复发性二尖瓣关闭不全的危险因素。
在 2003 年至 2015 年的 13 年中，术前特征的趋势表明无症状患者的比例显著增加。8 年总生存率、二尖瓣再手术无失败率和无复发性二尖瓣关闭不全率分别为 96%、96%和 85%。射血分数<60%、左心室舒张末期内径>60mm、单纯前叶病变和术中轻度残余二尖瓣关闭不全是复发性二尖瓣关闭不全的独立预测因素。早期干预组的复发性二尖瓣关闭不全发生率明显较低（3%比 18%，p<0.01）。在无症状患者的亚组分析中，无指南相关适应证患者的复发性二尖瓣关闭不全发生率明显较低（3%比 31%，p<0.0001）。
在出现症状、心房颤动和心室功能障碍之前，对严重退行性二尖瓣关闭不全患者进行早期手术干预可获得良好的临床结果。除了瓣叶病变的复杂性和修复质量外，手术时机也显著影响修复耐久性。因此，应推荐早期手术干预以降低复发性二尖瓣关闭不全的发生率。
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