Ma Kangmu, Chen Anqing, Wang Zhe, Liu Jun, Zhao Qiang
Department of Cardiac Surgery, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai 200025, China.
J Thorac Dis. 2019 Mar;11(3):827-838. doi: 10.21037/jtd.2019.02.17.
As an alternative to quadrangular resection (QR), little is known of the potential of chordal replacement (CR) for treating posterior mitral leaflet (PML) prolapse when comparing these two techniques. This study aimed to assess mid- to long-term outcomes of CR versus QR for isolated degenerative PML (idPML) repair.
We reviewed 112 consecutive patients using CR or QR for idPML repair from 4/2010 to 12/2015. Outcomes were compared before and after propensity score matching.
CR was more used through the minimally invasive approach (CR 59.4% QR 9.4%, P<0.001). At discharge mitral regurgitation (MR) was successfully rectified to a mild or less degree in both groups (CR P<0.001, QR P<0.001; between groups: P=0.337). Group CR showed much shorter postoperative time (CR 9.9±4.0 QR 14.0±8.3 days, P<0.004) and higher event-free survival rate between matched patients [56 months, CR 85.7% QR 30.8%, P (log-rank) =0.017], however QR showed better freedom from above-mild recurrent MR (MR ≥2.5+) during follow-up [60 months, CR 50.2% QR 96.3%, P (log-rank) =0.061]. Cox regression analysis might suggest that CR technique was a risk factor for recurrent MR [CR over QR, hazard ratio (HR) 2.149; 95% CI: 0.974-4.744; P=0.058; adjusted for surgical approach, gender, age, preoperative MR and ejection factor (EF)].
CR is more often used with the minimally invasive approach with less complications and shorter hospital stay. Nonetheless, CR is associated with recurrent MR development over time. Retaining of MV competence after CR demands attention and further investigation.
作为四边形切除术（QR）的替代方法，在比较这两种技术时，关于腱索置换术（CR）治疗二尖瓣后叶（PML）脱垂的潜力知之甚少。本研究旨在评估CR与QR治疗孤立性退行性PML（idPML）修复的中长期疗效。
我们回顾了2010年4月至2015年12月期间连续112例使用CR或QR进行idPML修复的患者。在倾向评分匹配前后比较结果。
CR更多地通过微创方法使用（CR 59.4%，QR 9.4%，P<0.001）。出院时，两组二尖瓣反流（MR）均成功纠正至轻度或更低程度（CR P<0.001，QR P<0.001；组间：P=0.337）。CR组术后时间明显更短（CR 9.9±4.0天，QR 14.0±8.3天，P<0.004），匹配患者的无事件生存率更高[56个月，CR 85.7%，QR 30.8%，P（对数秩）=0.017]，然而QR在随访期间显示出更好的免于中重度复发性MR（MR≥2.5+）[60个月，CR 50.2%，QR 96.3%，P（对数秩）=0.061]。Cox回归分析可能表明CR技术是复发性MR的一个危险因素[CR与QR相比，危险比（HR）2.149；95%可信区间：0.974-4.744；P=0.058；根据手术方式、性别、年龄、术前MR和射血因子（EF）进行调整]。
CR更常用于微创方法，并发症更少，住院时间更短。尽管如此，CR与随着时间推移复发性MR的发生有关。CR后维持二尖瓣功能需要关注并进一步研究。
