Vilnius University Faculty of Medicine, Clinic of Cardiac and Vascular Diseases, Vilnius, Lithuania.
Vilnius University Faculty of Medicine, Clinic of Cardiac and Vascular Diseases, Vilnius, Lithuania.
J Thorac Cardiovasc Surg. 2022 Dec;164(6):1820-1828. doi: 10.1016/j.jtcvs.2020.12.142. Epub 2021 Jan 20.
The study objective was to evaluate the midterm outcomes of transventricular mitral valve repair and its association with the initial anatomy of the mitral valve.
This nonrandomized observational study included 88 patients (mean age, 60 years; 69% were men) who underwent transventricular mitral valve repair for severe degenerative mitral regurgitation between 2011 and 2017. Mitral valve function was assessed by echocardiography at 1 and 6 months and annually after the procedure. According to the location of mitral valve pathology, all patients were stratified into 4 anatomic types (A, B, C, and D). Results were assessed using Kaplan-Meier method, mixed-effects continuation ratio model, and multivariable Cox regression.
Median follow-up of 42 months (interquartile range, 27-55) was complete for 83 patients (94.3%). There were 3 late deaths: 2 cardiac and 1 noncardiac. Recurrent mitral regurgitation greater than 2+ was observed in 29 patients (33%), and 18 patients (20.5%) underwent repeat surgery. Device success was 82% in type A at 6 months and thereafter; 87%, 85%, and 75% at 6, 12, and 36 months in type B, respectively; and 53% at 1 month and 20% at 24 months in type C. Probability of postoperative mitral regurgitation progression was higher in patients with greater preoperative left ventricular end-diastolic diameter, type B pathology, and type C pathology (P < .05). Risk factors of mitral regurgitation recurrence included increased left ventricle size (hazard ratio, 1.11; 95% confidence interval, 1.04-1.20; P = .001) and type C pathology (hazard ratio, 5.99; 95% confidence interval, 1.87-19.21; P = .003).
Initial acceptable mitral regurgitation reduction after transventricular mitral valve repair of isolated P2 prolapse was possible but found durable in only 82% at 3 years. Higher risk of mitral regurgitation recurrence occurred with complex degenerative pathology.
本研究旨在评估经心室二尖瓣修复术的中期疗效及其与二尖瓣初始解剖结构的关系。
本非随机观察性研究纳入了 2011 年至 2017 年间因严重退行性二尖瓣反流接受经心室二尖瓣修复术的 88 例患者（平均年龄 60 岁，69%为男性）。术后 1 个月、6 个月和每年通过超声心动图评估二尖瓣功能。根据二尖瓣病变的位置，所有患者均分为 4 种解剖类型（A、B、C 和 D）。采用 Kaplan-Meier 法、混合效应延续比模型和多变量 Cox 回归评估结果。
83 例患者（94.3%）中位随访 42 个月（四分位距 27-55）完整。随访期间死亡 3 例（2 例为心脏相关，1 例为非心脏相关）。29 例（33%）患者出现大于 2+级的复发性二尖瓣反流，18 例（20.5%）患者再次行手术治疗。6 个月时 A 型患者的手术成功率为 82%，此后分别为 87%、85%和 75%，B 型分别为 6 个月、12 个月和 36 个月，C 型分别为 1 个月和 24 个月。术前左心室舒张末期直径较大、B 型病变和 C 型病变的患者术后二尖瓣反流进展的可能性更高（P < 0.05）。二尖瓣反流复发的危险因素包括左心室增大（危险比 1.11，95%置信区间 1.04-1.20，P = 0.001）和 C 型病变（危险比 5.99，95%置信区间 1.87-19.21，P = 0.003）。
经心室二尖瓣修复术治疗孤立性 P2 脱垂患者，术后二尖瓣反流可得到初始可接受的减轻，但 3 年后仅 82%的患者可保持持久疗效。更复杂的退行性病变会增加二尖瓣反流复发的风险。
