Pfannmueller Bettina, Misfeld Martin, Verevkin Alexander, Garbade Jens, Holzhey David M, Davierwala Piroze, Seeburger Joerg, Noack Thilo, Borger Michael A
University Clinic of Cardiac Surgery, Leipzig Heart Center, Leipzig, Germany.
Eur J Cardiothorac Surg. 2021 Jan 4;59(1):180-186. doi: 10.1093/ejcts/ezaa255.
Non-leaflet resection techniques including loop chordal replacement are being used with increasing frequency, but the long-term results of these techniques are still unknown. The aim of this study was to compare the long-term results of loop neochord replacement with leaflet resection techniques in patients undergoing minimally invasive mitral valve (MV) repair for MV prolapse.
Between 1999 and 2014, 2134 consecutive MV prolapse patients underwent minimally invasive MV repair with isolated loop (n = 1751; 82.1%) or resection techniques (n = 383, 17.9%) at our institution. Follow-up data were available for 86% of patients with a mean follow-up time of 6.1 ± 4.3 years.
The 30-day mortality was 0.8% for all patients (loop: 0.7%, resection: 1.6%; P = 0.09). Leaflet resection was associated with more moderate or more mitral regurgitation on predischarge echocardiography (P = 0.003). The 1-, 5- and 10-year survival rates were 98 ± 1%, 95 ± 1% and 86 ± 2% for the loop technique versus 97 ± 1%, 92 ± 1% and 81 ± 2% for resection patients, respectively (P = 0.003). Significant predictors for late mortality were MV repair technique (P = 0.004), left ventricular ejection fraction (P < 0.001), age (P < 0.001) and myocardial infarction (P < 0.001). Freedom from MV reoperation at 1, 5 and 10 years was 98 ± 1%, 97 ± 1%, 97 ± 1% and 97 ± 1%, 97 ± 1%, 96 ± 1% for patients operated on with the loop technique and leaflet resection (P = 0.4).
In our patient cohort, MV repair with loop chordal replacement is associated with less early recurrent mitral regurgitation and very good long-term results when compared to classical leaflet resection techniques for MV prolapse and is therefore an excellent option for such patients.
包括襻状腱索置换在内的非瓣叶切除技术的使用频率日益增加，但这些技术的长期效果仍不明确。本研究旨在比较采用襻状新腱索置换术与瓣叶切除术治疗二尖瓣脱垂患者的长期效果，这些患者均接受微创二尖瓣修复术。
1999年至2014年期间，2134例连续性二尖瓣脱垂患者在我院接受了微创二尖瓣修复术，其中采用单纯襻状腱索置换术（n = 1751；82.1%）或切除术（n = 383，17.9%）。86%的患者有随访数据，平均随访时间为6.1±4.3年。
所有患者的30天死亡率为0.8%（襻状腱索置换术：0.7%，切除术：1.6%；P = 0.09）。瓣叶切除术与出院前超声心动图检查显示的中度或更严重二尖瓣反流相关（P = 0.003）。襻状腱索置换术患者的1年、5年和10年生存率分别为98±1%、95±1%和86±2%，而接受切除术患者的生存率分别为97±1%、92±1%和81±2%（P = 0.003）。晚期死亡的显著预测因素为二尖瓣修复技术（P = 0.004）、左心室射血分数（P < 0.001）、年龄（P < 0.001）和心肌梗死（P < 0.001）。采用襻状腱索置换术和瓣叶切除术的患者1年、5年和10年无二尖瓣再次手术的比例分别为98±1%、97±1%、97±1%和97±1%、97±1%、96±1%（P = 0.4）。
在我们的患者队列中，与经典的二尖瓣脱垂瓣叶切除技术相比，采用襻状腱索置换术进行二尖瓣修复术可减少早期二尖瓣反流复发，且长期效果良好，因此是这类患者的极佳选择。
