左心室收缩功能不全患者退行性二尖瓣反流的二尖瓣修复术：早期和中期结果
Mitral valve repair for degenerative mitral regurgitation in patients with left ventricular systolic dysfunction: early and mid-term outcomes.
作者信息
Li Jun, Zhao Yun, Zhou Tianyu, Wang Yongshi, Zhu Kai, Zhai Junyu, Sun Yongxin, Lai Hao, Wang Chunsheng
机构信息
Department of Cardiovascular Surgery, Zhongshan Hospital, Fudan University, 180 Fenglin Road, Shanghai, 200032, China.
Shanghai Institute of Cardiovascular Diseases, Zhongshan Hospital, Fudan University, 180 Fenglin Road, Shanghai, 200032, China.
出版信息
J Cardiothorac Surg. 2020 Oct 1;15(1):284. doi: 10.1186/s13019-020-01309-6.
BACKGROUND
This study aims to evaluate the early and mid-term outcomes of mitral valve repair for degenerative mitral regurgitation (MR) in patients with left ventricular systolic dysfunction.
METHODS
From January 2005 to December 2016, the profiles of patients with degenerative MR who underwent mitral valve repair at our institution were analyzed. Left ventricular systolic dysfunction was defined as an ejection fraction < 60% or left ventricular end-systolic dimension > 40 mm. Finally, 322 patients with left ventricular systolic dysfunction were included in this study. The prognosis of left ventricular function during follow-up was evaluated and preoperative factors associated with deteriorated left ventricular systolic function during follow-up were analyzed.
RESULTS
The in-hospital mortality rate was 1.6%. The rate of eight-year overall survival, freedom from reoperation for mitral valve and freedom from recurrent MR were 96.9, 91.2 and 73.4%, respectively. Intraoperative residual mild MR (hazard ratio 4.82) and an isolated anterior leaflet lesion (hazard ratio 2.48) were independent predictive factors for recurrent MR. During follow-up, 212 patients underwent echocardiography examinations at our institution. Among them, 132 patients had improved left ventricular systolic function, and 80 patients had deteriorated left ventricular systolic. Freedom from recurrent MR was found in 75.9% of the improved left ventricular systolic function group and 56.2% of the deteriorated left ventricular systolic function group (P = 0.047). An age > 50 years (odds ratio 2.40), ejection fraction≤52% (odds ratio 2.79) and left ventricular end-systolic dimension≥45 mm (odds ratio 2.31) were independent risk factors for deteriorated left ventricular systolic function during follow-up.
CONCLUSIONS
Mitral valve repair could be safely performed for degenerative MR in patients with left ventricular systolic dysfunction. Intraoperative residual mild MR and an isolated anterior leaflet lesion were independent predictive factors for recurrent MR. An age > 50 years, ejection fraction≤52% and left ventricular end-systolic dimension≥45 mm were independent risk factors for deteriorated left ventricular systolic function during follow-up.
背景
本研究旨在评估左心室收缩功能障碍患者退行性二尖瓣反流（MR）二尖瓣修复术的早期和中期结果。
方法
分析2005年1月至2016年12月在我院接受二尖瓣修复术的退行性MR患者资料。左心室收缩功能障碍定义为射血分数<60%或左心室收缩末期内径>40mm。最终，322例左心室收缩功能障碍患者纳入本研究。评估随访期间左心室功能的预后，并分析与随访期间左心室收缩功能恶化相关的术前因素。
结果
住院死亡率为1.6%。八年总生存率、二尖瓣免于再次手术率和免于复发性MR率分别为96.9%、91.2%和73.4%。术中残留轻度MR（风险比4.82）和孤立的前叶病变（风险比2.48）是复发性MR的独立预测因素。随访期间，212例患者在我院接受了超声心动图检查。其中，132例患者左心室收缩功能改善，80例患者左心室收缩功能恶化。左心室收缩功能改善组复发性MR免于率为75.9%，左心室收缩功能恶化组为56.2%（P=0.047）。年龄>50岁（比值比2.40）、射血分数≤52%（比值比2.79）和左心室收缩末期内径≥45mm（比值比2.31）是随访期间左心室收缩功能恶化的独立危险因素。
结论
对于左心室收缩功能障碍的退行性MR患者，二尖瓣修复术可安全进行。术中残留轻度MR和孤立的前叶病变是复发性MR的独立预测因素。年龄>50岁、射血分数≤52%和左心室收缩末期内径≥45mm是随访期间左心室收缩功能恶化的独立危险因素。
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