Department of Cardiovascular Surgery, University Heart Center Hamburg, Hamburg, Germany.
Department of Cardiology, University Heart Center Hamburg, Hamburg, Germany.
Eur J Cardiothorac Surg. 2019 Nov 1;56(5):968-975. doi: 10.1093/ejcts/ezz114.
Subannular repair techniques in addition to undersized ring annuloplasty have been developed to address high mitral regurgitation (MR) recurrence rates after mitral valve repair in type IIIb MR. We compared the results of annuloplasty with simultaneous standardized subannular repair versus isolated annuloplasty, focusing on the periprocedural outcomes of minimally invasive procedures.
A consecutive series of 108 patients with type IIIb functional MR with severe signs of bileaflet tethering underwent an annuloplasty + subannular repair (group A; n = 60) versus isolated annuloplasty (group B; n = 48). The primary end point of this prospective, parallel cohort study was death or recurrent MR >2, 1 year postoperatively. The secondary end points were survival and clinical outcomes, with special regard for the minimally invasively treated subgroups.
Duration of surgery, cardiopulmonary bypass time and aortic cross-clamp time were comparable between both study groups. Procedural outcomes as well as echocardiographic outcome parameters were similar and independent of access (fully endoscopic versus full sternotomy). At the 12-month follow-up, death or MR >2 occurred in 3.3% (2/60) of patients in group A vs in 20.8% (10/48) of patients in group B (P = 0.037). The overall mortality rate during the follow-up period was 1.7% (1/60) in group A vs 12.5% (6/48) in group B (P = 0.041).
Standardized realignment of papillary muscles is feasible and reproducible via a minimally invasive approach, resulting in excellent periprocedural outcomes, and has a clear potential to significantly decrease MR recurrence and improve 1-year outcomes compared to isolated annuloplasty.
除了采用小环成形术外，还开发了瓣环下修复技术，以解决 IIIb 型二尖瓣反流（MR）患者二尖瓣修复术后 MR 复发率高的问题。我们比较了瓣环成形术联合标准化瓣环下修复与单纯瓣环成形术的结果，重点关注微创治疗的围手术期结果。
连续纳入 108 例 IIIb 型功能性 MR 患者，伴有严重双叶瓣连枷样运动，接受瓣环成形术+瓣环下修复（A 组，n=60）或单纯瓣环成形术（B 组，n=48）。这项前瞻性平行队列研究的主要终点是术后 1 年死亡或复发 MR>2。次要终点是生存率和临床结果，特别关注微创治疗亚组。
两组手术时间、体外循环时间和主动脉阻断时间相当。手术结果和超声心动图结果参数相似，且与入路无关（完全内镜或全胸骨切开）。在 12 个月的随访中，A 组有 3.3%（2/60）的患者死亡或发生 MR>2，而 B 组有 20.8%（10/48）的患者（P=0.037）。A 组在随访期间的总死亡率为 1.7%（1/60），而 B 组为 12.5%（6/48）（P=0.041）。
通过微创途径实现乳头肌的标准化重新排列是可行且可重复的，可获得良好的围手术期结果，与单纯瓣环成形术相比，具有显著降低 MR 复发率和改善 1 年预后的明显潜力。
