Hiraoka Arudo, Hayashida Akihiro, Toki Misako, Chikazawa Genta, Yoshitaka Hidenori, Yoshida Kiyoshi, Sakaguchi Taichi
Department of Cardiovascular Surgery, The Sakakibara Heart Institute of Okayama, Japan.
Department of Cardiology, The Sakakibara Heart Institute of Okayama, Japan.
Int J Cardiol Heart Vasc. 2020 Apr 24;28:100517. doi: 10.1016/j.ijcha.2020.100517. eCollection 2020 Jun.
The aim of this study is to evaluate mitral valve hemodynamics after mitral valve repair for degenerative disease, and seek the impact of type/size of annuloplasty prosthesis on resting cardiac hemodynamics.
Between October 2012 and June 2019, 301 patients underwent isolated mitral valve repair for degenerative disease were enrolled. Correlation between postoperative mitral hemodynamics and type/size of annuloplasty prosthesis was evaluated.
There were significant correlations between annuloplasty size and peak velocity (r = -0.41, p < 0.001), peak transmitral pressure gradient (TMPG) (r = -0.40, p < 0.001), mean TMPG (r = -0.41, p < 0.001), effective orifice area (EOA) (r = 0.26, p < 0.001), and pulmonary artery systolic pressure (r = -0.15, p = 0.010). In patients with larger annuloplasty prostheses (≥30 mm), the type of annuloplasty prosthesis (band or ring) did not influence the mitral hemodynamics, however, mean TMPG was significantly greater in patients with a full ring (2.9 mmHg [2.1-3.7] vs. 4.0 mmHg [2.8-5.0], p < 0.001) in patients with smaller annuloplasty (<30 mm). Left ventricular ejection fraction and stroke volume were significantly associated with an increase of TMPG (r = 0.14, p = 0.016 and r = 0.24, p < 0.001).
A larger partial band had the potential to improve mitral hemodynamics after mitral repair for degenerative disease. However, echocardiographic mitral hemodynamics was influenced by LV function. Therefore, a more accurate method is required to elucidate the true impact of mitral repair on hemodynamics.
本研究旨在评估退行性疾病二尖瓣修复术后的二尖瓣血流动力学，并探讨瓣环成形假体的类型/尺寸对静息心脏血流动力学的影响。
2012年10月至2019年6月，纳入301例行退行性疾病单纯二尖瓣修复术的患者。评估术后二尖瓣血流动力学与瓣环成形假体类型/尺寸之间的相关性。
瓣环成形尺寸与峰值流速（r = -0.41，p < 0.001）、峰值二尖瓣跨瓣压差（TMPG）（r = -0.40，p < 0.001）、平均TMPG（r = -0.41，p < 0.001）、有效瓣口面积（EOA）（r = 0.26，p < 0.001）和肺动脉收缩压（r = -0.15，p = 0.010）之间存在显著相关性。在瓣环成形假体较大（≥30 mm）的患者中，瓣环成形假体的类型（带或环）不影响二尖瓣血流动力学，然而，在瓣环成形较小（<30 mm）的患者中，全环患者的平均TMPG显著更高（2.9 mmHg [2.1 - 3.7] 对比 4.0 mmHg [2.8 - 5.0]，p < 0.001）。左心室射血分数和每搏输出量与TMPG升高显著相关（r = 0.14，p = 0.016和r = 0.24，p < 0.001）。
较大的部分带瓣环成形术有可能改善退行性疾病二尖瓣修复术后的二尖瓣血流动力学。然而，超声心动图二尖瓣血流动力学受左心室功能影响。因此，需要一种更准确的方法来阐明二尖瓣修复对血流动力学的真正影响。
