Noack Thilo, Marin Cuartas Mateo, Kiefer Philipp, Garbade Jens, Pfannmueller Bettina, Seeburger Joerg, Borger Michael A
University Department of Cardiac Surgery, Heart Center Leipzig, Leipzig, Germany.
Ann Thorac Cardiovasc Surg. 2019 Dec 20;25(6):326-335. doi: 10.5761/atcs.oa.19-00093. Epub 2019 Oct 4.
This study aims to analyze the clinical outcomes after isolated mitral valve (MV) repair in patients with reduced left ventricular ejection fraction (LVEF <50%) with focus on perioperative characteristics, survival, and freedom from reoperations.
Between 1997 and 2015, 557 patients with reduced LVEF (age: 62.8 ± 11.7 years, male: 320) underwent MV repair for symptomatic mitral regurgitation (MR). Etiologies were dilated non-ischemic cardiomyopathy and ischemic cardiomyopathy in 487 (87.4%) and 70 (12.6%) patients, respectively; these were classified into three different subgroups: LVEF 40%-49% (group 1), 30%-39% (group 2), and <30% (group 3).
Overall, 294, 145, and 118 patients had an LVEF of 40%-49%, 30%-39%, and <30%, respectively. Logistic EuroSCORE was significantly higher (P <0.001) as the LVEF worsened. The survival analysis for groups 1-3, respectively, revealed the following: 30-day mortality: 1.4%, 3.4%, and 7.6% (P <0.001); 1-year survival: 93.9%, 89.4%, and 82% (P <0.001); 5-year survival: 81.2%, 75.2%, and 58% (P <0.001).
MV repair in patients with impaired LVEF could be performed safely with good clinical short- and mid-term outcome. Nevertheless, reduced preoperative LVEF correlates with worse perioperative and long-term survival.
本研究旨在分析左心室射血分数降低（LVEF<50%）的患者单纯二尖瓣（MV）修复术后的临床结果，重点关注围手术期特征、生存率和再次手术的自由度。
1997年至2015年间，557例LVEF降低的患者（年龄：62.8±11.7岁，男性：320例）因症状性二尖瓣反流（MR）接受了MV修复术。病因分别为扩张型非缺血性心肌病和缺血性心肌病，共487例（87.4%）和70例（12.6%）；这些患者被分为三个不同亚组：LVEF 40%-49%（第1组）、30%-39%（第2组）和<30%（第3组）。
总体而言，分别有294例、145例和118例患者的LVEF为40%-49%、30%-39%和<30%。随着LVEF恶化，逻辑欧洲心脏手术风险评估系统（Logistic EuroSCORE）显著升高（P<0.001）。第1-3组的生存分析结果分别如下：30天死亡率：1.4%、3.4%和7.6%（P<0.001）；1年生存率：93.9%、89.4%和82%（P<0.001）；5年生存率：81.2%、75.2%和58%（P<0.001）。
LVEF受损患者的MV修复术可以安全进行，且具有良好的临床短期和中期结果。然而，术前LVEF降低与围手术期和长期生存率较差相关。
