Han Jie, Tian Baiyu, Wu Fang, Jiao Yuqing, Pang Shuai, Xu Jinguo, Meng Xu
Cardiac Valve Center, Department of Cardiac Surgery, Beijing Anzhen Hospital, Capital Medical University-Beijing Institute of Heart Lung and Blood Vessel Diseases, Beijing, China.
Center of Cardiovascular Surgery, the People's Hospital of Huaiyin Jinan, Jinan, China.
J Thorac Dis. 2020 Nov;12(11):6752-6760. doi: 10.21037/jtd-20-1694.
Many comparative studies of percutaneous balloon mitral valvuloplasty (PBMV) and surgical mitral commissurotomy (SMC) in rheumatic mitral stenosis (MS) were done in the last few decades. With the development of valve repair techniques, various surgical rheumatic valve repair techniques have been applied in clinic, but there is a lack of comparison with PBMV. Our study was designed to compare the perioperative and mid-term outcomes of PBMV and mitral valve repair with "four-step" procedure in the treatment of rheumatic MS.
Patients with MS were treated with PBMV or rheumatic mitral valve repair (rMVP) at Beijing Anzhen Hospital between January 1, 2013 and September 30, 2018 were selected. By using propensity score matching (PSM) method, we compared the changes in post-operation clinical outcomes between the two matched groups. Kaplan-Meier analyses was used for survival analysis and drawing the curve, and log-rank test were used to compare intergroup differences.
A total of 252 cases were enrolled after selection, 74 cases in PBMV and 178 cases in rMVP. Seventy-four pairs were matched successfully after PSM. There were 53 females in PBMV and 54 in rMVP. The mean age of two groups was 46.95±12.50 and 47.55±11.91 years respectively. There was no significantly differences in mitral valve orifice area (MVOA) (1.05±0.32 0.97±0.24 cm, P=0.12) and left ventricular ejection fraction (EF) (62.36%±5.17% 62.52%±4.94%, P=0.76) between two groups preoperatively. Baseline characteristics were basically balanced after PSM. In each group, there was one case transferred to surgical mitral valve replacement due to the failure of valvuloplasty before discharge. All patients survived the interventions and no severe complications were found. MVOA were significantly increased in rMVP compared with PBMV postoperatively, as well as grading of MS and tricuspid regurgitation (TR) were significantly improved in rMVP. Three cases in PBMV were lost during the follow-up. Mitral replacement was performed in 11 patients and one of them died in PBMV, while none of patients underwent re-intervention in rMVP, but one patient died of pneumonia.
For selected patients with rheumatic MS in China, our study shows that there are comparable clinical outcomes in terms of operative, mid-term mortality and complications between PBMV and surgical rMVP with "four-step" procedure. Surgical rMVP shows more advantageous in the correction of valve stenosis and the management of concomitant tricuspid valve lesions and atrial fibrillation (AF).
在过去几十年中，针对风湿性二尖瓣狭窄（MS）开展了许多经皮球囊二尖瓣成形术（PBMV）与外科二尖瓣交界切开术（SMC）的比较研究。随着瓣膜修复技术的发展，各种外科风湿性瓣膜修复技术已应用于临床，但缺乏与PBMV的比较。我们的研究旨在比较PBMV与采用“四步法”的二尖瓣修复术治疗风湿性MS的围手术期及中期结局。
选取2013年1月1日至2018年9月30日在北京安贞医院接受PBMV或风湿性二尖瓣修复术（rMVP）治疗的MS患者。采用倾向评分匹配（PSM）方法，比较两个匹配组术后临床结局的变化。采用Kaplan-Meier分析进行生存分析并绘制曲线，采用对数秩检验比较组间差异。
入选后共纳入252例患者，PBMV组74例，rMVP组178例。PSM后成功匹配74对。PBMV组有53例女性，rMVP组有54例女性。两组的平均年龄分别为46.95±12.50岁和47.55±11.91岁。术前两组的二尖瓣口面积（MVOA）（1.05±0.32对0.97±0.24 cm，P = 0.12）和左心室射血分数（EF）（62.36%±5.17%对62.52%±4.94%，P = 0.76）无显著差异。PSM后基线特征基本平衡。每组各有1例因瓣膜成形术失败在出院前转为外科二尖瓣置换术。所有患者均在干预后存活，未发现严重并发症。与PBMV相比，rMVP术后MVOA显著增加，MS分级及三尖瓣反流（TR）也显著改善。PBMV组有3例在随访期间失访。PBMV组有11例患者接受了二尖瓣置换术，其中1例死亡，而rMVP组无患者接受再次干预，但有1例患者死于肺炎。
对于中国选定的风湿性MS患者，我们的研究表明，PBMV与采用“四步法”的外科rMVP在手术、中期死亡率和并发症方面的临床结局具有可比性。外科rMVP在纠正瓣膜狭窄以及处理合并的三尖瓣病变和心房颤动（AF）方面显示出更具优势。
