Kilic Arman, Helmers Mark R, Han Jason J, Kanade Rahul, Acker Michael A, Hargrove Walter Clark, Atluri Pavan
Division of Cardiac Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania.
Division of Cardiovascular Surgery, University of Pennsylvania, Philadelphia, Pennsylvania.
J Card Surg. 2018 Dec;33(12):772-777. doi: 10.1111/jocs.13944. Epub 2018 Dec 12.
The optimal treatment strategy following a failed mitral valve repair remains unclear. This study evaluated early and long-term outcomes of redo mitral valve repair (MVr) and replacement (MVR) after prior mitral valve repair.
Patients undergoing redo mitral valve surgery after prior mitral valve repair at a single institution between 2002 and 2014 were reviewed. Primary outcomes included operative mortality (30-day or in-hospital mortality) and long-term freedom from mitral valve reoperation and death. Secondary outcomes included postoperative complications.
305 patients underwent redo MVr (n = 48) or MVR (n = 257) after prior mitral valve repair. Concomitant procedures included tricuspid valve repair or replacement (23%), aortic valve replacement (6%), and coronary artery bypass grafting (4%), with no differences between cohorts. 18% were performed via right mini-thoracotomy (24% MVr vs 18% MVR, P = 0.31). Unadjusted and risk-adjusted operative mortality were lower with MVr (0% vs 8%, P = 0.04). Rates of postoperative complications were similar except for blood product transfusion (35% MVr vs 59% MVR, P = 0.003) and prolonged mechanical ventilation (8% MVr vs 29% MVR, P = 0.003). Long-term freedom from mortality was comparable: 96% MVr versus 86% MVR at 1 year and 78% MVr versus 68% MVR at 5 years (P = 0.29).
When technically feasible, mitral valve re-repair can be safely performed with outcomes comparable to MVR.
二尖瓣修复失败后的最佳治疗策略仍不明确。本研究评估了二尖瓣修复术后再次进行二尖瓣修复（MVr）和置换（MVR）的早期和长期结果。
回顾了2002年至2014年间在单一机构接受二尖瓣修复术后再次进行二尖瓣手术的患者。主要结局包括手术死亡率（30天或住院死亡率）以及二尖瓣再次手术和死亡的长期免发生率。次要结局包括术后并发症。
305例患者在二尖瓣修复术后接受了再次MVr（n = 48）或MVR（n = 257）。同期手术包括三尖瓣修复或置换（23%）、主动脉瓣置换（6%）和冠状动脉旁路移植术（4%），两组之间无差异。18%的手术通过右胸小切口进行（MVr为24%，MVR为18%，P = 0.31）。MVr的未调整和风险调整后的手术死亡率较低（0%对8%，P = 0.04）。除血液制品输注（MVr为35%，MVR为59%，P = 0.003）和机械通气时间延长（MVr为8%，MVR为29%，P = 0.003）外，术后并发症发生率相似。长期生存免发生率相当：1年时MVr为96%，MVR为86%；5年时MVr为78%，MVR为68%（P = 0.29）。
在技术可行时，二尖瓣再次修复可安全进行，其结果与MVR相当。
