Ma Jiexu, Liu Jian, Wei Peijian, Yao Ximeng, Zhang Yuyuan, Fang Liangzheng, Chen Zhao, Liu Yanjun, Tan Tong, Wu Hongxiang, Huang Huanlei, Xie Bin, Chen Jimei, Zhuang Jian, Guo Huiming
Department of Cardiovascular Surgery, Guangdong Provincial Key Laboratory of South China Structural Heart Disease, Guangdong Cardiovascular Institute, Guangdong Provincial People's Hospital (Guangdong Academy of Medical Sciences), Guangzhou, China.
Medical College, Shantou University, Shantou, China.
Ann Transl Med. 2021 Jan;9(1):60. doi: 10.21037/atm-20-7475.
The aims of the present study was to compare midterm results of quadrangular leaflet resection versus chordal replacement for the repair of degenerative posterior mitral leaflet (PML) prolapse, and to explore the risk factors for recurrent severe mitral regurgitation (MR).
From January 2012 to December 2018, 1,423 consecutive patients underwent mitral valve (MV) repair. A total of 317 had degenerative PML prolapse and constituted the study population. Of these, 74 (23.3%) underwent quadrangular leaflet resection, and 243 (76.7%) underwent chordal replacement. Outcomes were compared by using unadjusted data and propensity score-matched analyses.
Patients with multiple leaflet prolapse were more likely to undergo chordal replacement (18.4% 41.9%, P<0.001), and performed as a minimally invasive approach (47.3% 61.7%, P=0.027). Of the entire cohort, 1 death (0.3%) occurred due to intraoperative aortic dissection, and 1 patient who had undergone chordal replacement required reoperation before discharge for posterior leaflet tearing. There was no significant difference in the probability of freedom from recurrent severe MR at 82 months between the resection and neochordae groups in both the pre-matched (95.6% 88.8%, P=0.105) and matched (95.2% 88.5%, P=0.170) cohorts, which was consistent across all of the examined subgroups (P>0.05). Multivariate Cox regression indicated that dilated left ventricular end-systolic diameter (LVESD) was an independent risk factor for recurrent severe MR [<40 >40 mm, hazards ratio (HR): 3.17, 95% confidence interval (CI): 1.20-8.39, P=0.020]; however, surgical technique was not (resection neochordae, HR: 0.31, 95% CI: 0.07-1.37, P=0.122).
Chordal replacement for the repair of degenerative posterior MV prolapse yields similar satisfactory outcomes when compared with quadrangular resection, and is promising in minimally invasive cardiac surgery for various lesions. However, it is also associated with more recurrent severe MR, albeit non-significant, for which patients with dilated LVESD are at high risk.
本研究旨在比较四边形瓣叶切除术与腱索置换术治疗退行性二尖瓣后叶（PML）脱垂的中期结果，并探讨复发性严重二尖瓣反流（MR）的危险因素。
2012年1月至2018年12月，1423例连续患者接受二尖瓣（MV）修复术。共有317例患有退行性PML脱垂，构成研究人群。其中，74例（23.3%）接受四边形瓣叶切除术，243例（76.7%）接受腱索置换术。通过使用未调整数据和倾向评分匹配分析比较结果。
多瓣叶脱垂患者更有可能接受腱索置换术（18.4%对41.9%，P<0.001），并且作为微创方法进行（47.3%对61.7%，P=0.027）。在整个队列中，1例（0.3%）因术中主动脉夹层死亡，1例接受腱索置换术的患者在出院前因后叶撕裂需要再次手术。在未匹配队列（95.6%对88.8%，P=0.105）和匹配队列（95.2%对88.5%，P=0.170）中，切除组和新腱索组在82个月时无复发性严重MR的概率无显著差异，在所有检查的亚组中均一致（P>0.05）。多变量Cox回归表明，左心室舒张末期内径（LVESD）扩大是复发性严重MR的独立危险因素[<40对>40 mm，风险比（HR）：3.17，95%置信区间（CI）：1.20-8.39，P=0.020]；然而，手术技术不是（切除对新腱索，HR：0.31，95%CI：0.07-1.37，P=0.122）。
与四边形切除术相比，腱索置换术治疗退行性二尖瓣后叶脱垂的效果相似，令人满意，并且在微创心脏手术治疗各种病变方面很有前景。然而，它也与更多的复发性严重MR相关，尽管不显著，LVESD扩大的患者对此风险较高。
