Malhotra Amber, Siddiqui Sumbul, Wadhawa Vivek, Pandya Himani, Patel Kartik, Shah Komal, Gandhi Hemang, Garg Pankaj, Adalti Sudhir, Sharma Kamal
Department of Cardio Vascular and Thoracic Surgery, U. N. Mehta Institute of Cardiology and Research Center (affiliated to BJ Medical College, Ahmedabad), Civil Hospital Campus, Asarwa, Ahmedabad, Gujarat 380016 India.
Department of Research, U. N. Mehta Institute of Cardiology and Research Center (affiliated to BJ Medical College, Ahmedabad), Ahmedabad, Gujarat India.
Indian J Thorac Cardiovasc Surg. 2019 Jan;35(1):15-24. doi: 10.1007/s12055-018-0721-4. Epub 2018 Oct 9.
Carpentier's classification has been used to classify both stenotic and regurgitant lesions. However, given the extreme variability of lesions, a universal nomenclature suggestive of the complexity and the prognosis of the repair procedure for the entire spectrum of the mitral valve disease still remains elusive. We present the predictors of mitral valve repairability with the help of a four-level-based 'CLAS' scoring system.
A total of 394 patients undergoing mitral valve procedure were prospectively studied. The valvular apparatus was divided into four sub-units, namely Commissures (C), Leaflet (L), Annulus (A), and Subvalvular apparatus (S), and the components were scored individually and the summation scores were calculated. Based on our results, three CLAS groups were formulated.
A total of 376 ( = 394) patients underwent successful MVRep (95.43%; on-table failure in 18 patients). A total of 276 were rheumatic, 51 degenerative, 28 congenital, and 16 had infective endocarditis. Thirty-day mortality was 14 (3.72%) while delayed re-intervention rate was 8 (2.12%). The mean follow-up period was 30 months. One hundred percent patients with a CLAS score ≤ 8 had a successful repair as compared to 93.33 and 69.69%, respectively, for patients with scores between 9 and 12 and > 12, respectively. The cardio pulmonary bypass time, aortic-cross-clamp time, and ICU stay also showed a significant correlation with the patient's 'CLAS' groups.
The CLAS score is highly predictive of a successful repair. We thus propose that, in the patients with a score of ≤ 8, repair should always be attempted irrespective of the pathology. The patients expected to be scored > 8 should be referred to a repair reference center.
Carpentier分类法已用于对狭窄和反流性病变进行分类。然而，鉴于病变的极端变异性，对于二尖瓣疾病全谱而言，一种能提示修复手术复杂性和预后的通用命名法仍然难以捉摸。我们借助基于四级的“CLAS”评分系统介绍二尖瓣修复可行性的预测因素。
对394例行二尖瓣手术的患者进行前瞻性研究。瓣膜装置分为四个亚单位，即瓣叶交界（C）、瓣叶（L）、瓣环（A）和瓣下装置（S），分别对各组成部分进行评分并计算总分。根据我们的结果，制定了三个CLAS组。
共有376例（=394）患者二尖瓣修复成功（95.43%；18例术中修复失败）。其中风湿性病变276例，退行性病变51例，先天性病变28例，感染性心内膜炎16例。30天死亡率为14例（3.72%），延迟再次干预率为8例（2.12%）。平均随访期为30个月。CLAS评分≤8分的患者修复成功率为100%，而评分在9至12分之间和＞12分的患者修复成功率分别为93.33%和69.69%。体外循环时间、主动脉阻断时间和重症监护病房停留时间也与患者的“CLAS”组显著相关。
CLAS评分对成功修复具有高度预测性。因此，我们建议，对于评分≤8分的患者，无论病理情况如何，均应尝试进行修复。预计评分＞8分的患者应转诊至修复参考中心。
