Division of Cardiac Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania.
Division of Cardiac Surgery, University of Pennsylvania, Philadelphia, Pennsylvania.
Ann Thorac Surg. 2019 Mar;107(3):754-759. doi: 10.1016/j.athoracsur.2018.08.083. Epub 2018 Oct 23.
This study evaluated outcomes of reoperative mitral valve surgery (MVS) in the United States.
Adults undergoing isolated MVS with prior open-heart operation in The Society of Thoracic Surgeons (STS) National Database between July 2011 and September 2016 were included. Urgent or emergent operations as well as all indications and causes for MVS were included. Primary outcomes were operative mortality and morbidity. Multivariable models were used for risk-adjustment, incorporating variables from the STS Valve Risk Model as well as type of prior operation and reoperative approach.
A total of 17,195 patients underwent isolated reoperative MVS at 962 centers. The STS predicted risk of mortality was 8.0%, with 20% having an STS predicted risk of mortality greater than 10%. Prior cardiac operations included previous MVS (61%), coronary artery bypass (39%), aortic valve surgery (18%), and tricuspid valve surgery (6%). Operative mortality for the overall study cohort was 6.6%, and postoperative stroke occurred in 2.4%. Observed-to-expected mortality for the overall cohort was 0.82. The strongest independent predictors of operative mortality included salvage operation, preoperative dialysis dependence, congestive heart failure, recent myocardial infarction, and active endocarditis. Prior aortic valve replacement was associated with increased mortality risk, whereas prior MVS reduced mortality risk. Surgical approach did not affect mortality. For patients with prior MVS undergoing elective, non-endocarditis operations, the operative mortality was 3.4%.
Despite a high-risk patient profile, surgical outcomes of reoperative MVS were acceptable, particularly in patients with prior MVS and without endocarditis undergoing elective operations.
本研究评估了美国再次行二尖瓣手术（MVS）的结果。
纳入 2011 年 7 月至 2016 年 9 月期间在胸外科医师学会（STS）国家数据库中接受过单纯二尖瓣再次手术且既往有开胸手术的成年人。包括紧急或急症手术以及二尖瓣手术的所有适应证和病因。主要结局是手术死亡率和发病率。多变量模型用于风险调整，纳入 STS 瓣膜风险模型中的变量以及既往手术类型和再次手术方法。
共有 17195 例患者在 962 个中心接受了单纯再次二尖瓣手术。STS 预测的死亡率风险为 8.0%，其中 20%的患者 STS 预测死亡率风险大于 10%。既往心脏手术包括先前的二尖瓣手术（61%）、冠状动脉旁路移植术（39%）、主动脉瓣手术（18%）和三尖瓣手术（6%）。整个研究队列的手术死亡率为 6.6%，术后发生脑卒中 2.4%。整个队列的观察到的与预期的死亡率为 0.82。手术死亡率的独立预测因素包括抢救手术、术前透析依赖、充血性心力衰竭、近期心肌梗死和活动性心内膜炎。既往主动脉瓣置换与死亡率风险增加相关，而既往二尖瓣手术降低了死亡率风险。手术方法不影响死亡率。对于既往二尖瓣手术且无心内膜炎的择期非心内膜炎手术患者，手术死亡率为 3.4%。
尽管患者的风险状况较高，但再次行二尖瓣手术的手术结果是可以接受的，尤其是对于既往有二尖瓣手术且无心内膜炎的患者进行择期手术。
