Department of Cardiovascular Surgery, Tokai University School of Medicine, 143 Shimokasuya, Isehara, Kanagawa, 259-1193, Japan.
Department of Cardiovascular and Thoracic Surgery, Hokakaido University Graduate School of Medicine, Sapporo, Japan.
Gen Thorac Cardiovasc Surg. 2021 Apr;69(4):679-689. doi: 10.1007/s11748-020-01512-1. Epub 2020 Oct 24.
There is uncertainty over the efficacy of additional surgical ventricular reconstruction (SVR) associated with mitral valve operation for non-ischaemic dilated cardiomyopathy (DCM). This study aims to assess mid-term outcomes of these non-heart transplant surgical approaches for DCM.
We reviewed retrospectively 106 patients (median age 64, 44 females) who underwent isolated mitral annular plasty (MAP; n = 34), mitral valve replacement (MVR; n = 29), and SVR associated with MAP (SVR + MAP; n = 43) for DCM, in 11 Japanese hospitals. We analysed mid-term outcomes, specifically freedom from cardiac death and cardiac event.
Hospital deaths occurred in 16 patients (15.1%) and cardiac deaths in 36 patients (34.0%) during the study period of 4.4 ± 3.5 years. Freedom from cardiac death at 7 years in patients undergoing MAP, MVR, and SVR + MAP were, respectively, 79.1%, 82.6%, and 29.5% (P < 0.0001). Freedom from cardiac event at 7 years in patients undergoing MAP, MVR, and SVR + MAP were, respectively, 42.8%, 59.9%, 22.6% (P = 0.0004). In the multivariable analyses, preoperative tricuspid regurgitation (TR) grade was the only risk factor for both cardiac death and event, whereas MVR for DCM emerged as a protective factor for cardiac event.
This study could not show any benefit of additional SVR, by means of volume reduction, to MAP, because the baseline characteristics were different even after the stratification of DCM grade. MVR can be performed with favorable mid-term outcomes even in patients with advanced DCM, while patients undergoing MAP with/without SVR had more frequent MR recurrence or cardiac events. Interestingly, the right ventricular feature is a predictor of both cardiac death and events, with the TR grade being a predictor of poor mid-term outcomes.
对于非缺血性扩张型心肌病（DCM），二尖瓣手术联合外科心室重建（SVR）的疗效尚不确定。本研究旨在评估这些非心脏移植手术方法治疗 DCM 的中期结果。
我们回顾性分析了 11 家日本医院 106 例（中位年龄 64 岁，44 例女性）接受单纯二尖瓣环成形术（MAP；n=34）、二尖瓣置换术（MVR；n=29）和 MAP 联合 SVR（SVR+MAP；n=43）的 DCM 患者的中期结果，分析了无心脏死亡和心脏事件的生存率。
研究期间（4.4±3.5 年），共有 16 例（15.1%）患者发生院内死亡，36 例（34.0%）患者发生心脏死亡。MAP、MVR 和 SVR+MAP 组患者 7 年无心脏死亡生存率分别为 79.1%、82.6%和 29.5%（P<0.0001）。MAP、MVR 和 SVR+MAP 组患者 7 年无心脏事件生存率分别为 42.8%、59.9%和 22.6%（P=0.0004）。多变量分析显示，术前三尖瓣反流（TR）分级是心脏死亡和事件的唯一危险因素，而 MVR 是 DCM 心脏事件的保护因素。
本研究不能证明 MAP 联合 SVR （通过容积减少）有任何益处，因为即使在 DCM 分级分层后，基线特征也不同。即使在晚期 DCM 患者中，MVR 也能获得良好的中期结果，而接受 MAP 联合或不联合 SVR 的患者则有更多的 MR 复发或心脏事件。有趣的是，右心室特征是心脏死亡和事件的预测因素，TR 分级是预测中期不良结果的因素。
