Department of Cardiovascular Surgery, The Sakakibara Heart Institute of Okayama, Japan.
Department of Cardiovascular Surgery, The Sakakibara Heart Institute of Okayama, Japan.
Semin Thorac Cardiovasc Surg. 2022 Spring;34(1):54-60. doi: 10.1053/j.semtcvs.2021.02.005. Epub 2021 Feb 15.
Downsizing of mitral annulus due to mitral annuloplasty for ischemic functional mitral regurgitation (FMR) raises a new issue, functional mitral stenosis (FMS), defined as a decline of mitral hemodynamics. However, common mitral hemodynamic parameters are influenced by transmitral flow, therefore, the clinical impacts are still controversial. The aim of this study is to seek mitral hemodynamic indices (including transmitlra pressure gradient [TMPG] adjusted by left ventricular stroke volume [LVSV]) relevant to the mid-term outcomes after annuloplasty for ischemic functional mitral regurgitation (FMR). This study is a retrospective evaluation of mitral valve hemodynamic status by resting echocardiogram at several weeks after surgery. Eighty-one patients underwent mitral annuloplasty for ischemic FMR between September 2012 and June 2019. Postoperative adverse events occurred in 28 patients (34.6%), and the overall 5-year freedom from adverse events rate was 55.9%. Common mitral hemodynamic parameters were not associated with adverse events, but flow adjusted TMPG can be a correlative factor. By multivariable analysis, postoperative systolic pulmonary artery pressure and peak TMPG/LVSV were detected as independent predictors (adjusted hazard ratio 1.07 and 1.08, P < 0.001 and < 0.001). Additionally, risk stratification by peak TMPG (cut-off: 10 mm Hg) and LVSV (cut-off: 35 mL/m) reflected the mid-term outcomes, perceptively (P = 0.007). Conventional mitral hemodynamic parameters were not associated with adverse cardiac events after annuloplasty for ischemic FMR. However, flow adjusted TMPG was identfied as an independent predictor, and risk stratification by peak TMPG and LVSV reflected the mid-term outcomes, perceptively.
由于缺血性功能性二尖瓣反流（FMR）的二尖瓣环成形术导致二尖瓣环缩小，引发了一个新问题，即功能性二尖瓣狭窄（FMS），定义为二尖瓣血流动力学下降。然而，常见的二尖瓣血流动力学参数受跨瓣血流影响，因此其临床影响仍存在争议。本研究旨在寻找与缺血性功能性二尖瓣反流（FMR）瓣环成形术后中期结果相关的二尖瓣血流动力学指标（包括通过左心室射血量[LVSV]校正的跨瓣压力梯度[TMPG]）。本研究回顾性评估了 81 例因缺血性 FMR 行二尖瓣环成形术患者术后数周的二尖瓣瓣膜血流动力学状态。术后 28 例（34.6%）发生不良事件，整体 5 年无不良事件生存率为 55.9%。常见的二尖瓣血流动力学参数与不良事件无关，但经流量校正的 TMPG 可作为相关因素。多变量分析显示，术后收缩期肺动脉压和峰值 TMPG/LVSV 是独立预测因子（校正后的危险比分别为 1.07 和 1.08，P＜0.001 和＜0.001）。此外，通过峰值 TMPG（截值：10mmHg）和 LVSV（截值：35mL/m）进行风险分层可以敏感地反映中期结果（P=0.007）。缺血性 FMR 瓣环成形术后，常规二尖瓣血流动力学参数与不良心脏事件无关。然而，经流量校正的 TMPG 被确定为独立预测因子，通过峰值 TMPG 和 LVSV 进行风险分层可以敏感地反映中期结果。
