孤立性二尖瓣后叶瓣叶脱垂的二尖瓣修复术：保留和切除技术对左心室功能的影响。

Mitral valve repair for isolated posterior mitral valve leaflet prolapse: The effect of respect and resect techniques on left ventricular function.

机构信息

Division of Cardiac Imaging, Department of Cardiology, Leiden University Medical Center, Leiden, The Netherlands.

Division of Cardiothoracic Surgeons, Department of Cardiothoracic Surgery, Leiden University Medical Center, Leiden, The Netherlands.

出版信息

J Thorac Cardiovasc Surg. 2022 Nov;164(5):1488-1497.e3. doi: 10.1016/j.jtcvs.2021.02.017. Epub 2021 Feb 23.

DOI:10.1016/j.jtcvs.2021.02.017

PMID:33744010

Abstract

OBJECTIVE

Posterior mitral valve leaflet prolapse repair can be performed by leaflet resection or chordal replacement techniques. The impact of these techniques on left ventricular function remains a topic of debate, considering the presumed better preservation of mitral-ventricular continuity when leaflet resection is avoided. We explored the effect of different posterior mitral valve leaflet repair techniques on postoperative left ventricular function.

METHODS

In total, 125 patients were included and divided into 2 groups: leaflet resection (n = 82) and isolated chordal replacement (n = 43). Standard and advanced echocardiographic assessments were performed preoperatively, directly postoperatively, and at late follow-up. In addition, left ventricular global longitudinal strain was measured and corrected for left ventricular end-diastolic volume to adjust for the significant changes in left ventricular volumes.

RESULTS

At baseline, no significant intergroup difference in left ventricular function was observed measured with the corrected left ventricular global longitudinal strain (resect: 1.76% ± 0.58%/10 mL vs respect: 1.70% ± 0.57%/10 mL, P = .560). Postoperatively, corrected left ventricular global longitudinal strain worsened in both groups but improved significantly during late follow-up, returning to preoperative values (resect: 1.39% ± 0.49% to 1.71% ± 0.56%/10 mL, P < .001 and respect: 1.30% ± 0.45% to 1.70% ± 0.54%/10 mL, P < .001). Mixed model analysis showed no significant effect on the corrected left ventricular global longitudinal strain when comparing the 2 different surgical repair techniques over time (P = .943).

CONCLUSIONS

Our study showed that both leaflet resection and chordal replacement repair techniques are effective at preserving postoperative left ventricular function in patients with posterior mitral valve leaflet prolapse and significant regurgitation.

摘要

目的

后瓣叶二尖瓣脱垂修复可采用瓣叶切除术或腱索置换技术。由于避免瓣叶切除时可更好地保留二尖瓣-心室连续性，这些技术对左心室功能的影响仍存在争议。我们探讨了不同的后瓣叶二尖瓣修复技术对术后左心室功能的影响。

方法

共纳入 125 例患者，分为两组：瓣叶切除术（n=82）和单纯腱索置换术（n=43）。术前、术后即刻和晚期随访时进行标准和高级超声心动图评估。此外，还测量了左心室整体纵向应变，并根据左心室容积的显著变化进行校正，以调整左心室容积。

结果

基线时，校正后的左心室整体纵向应变无明显组间差异（切除：1.76%±0.58%/10 mL 比 1.70%±0.57%/10 mL，P=0.560）。术后两组校正后的左心室整体纵向应变均恶化，但在晚期随访中明显改善，恢复至术前水平（切除：1.39%±0.49%至 1.71%±0.56%/10 mL，P<0.001；尊重：1.30%±0.45%至 1.70%±0.54%/10 mL，P<0.001）。混合模型分析显示，两种不同的手术修复技术在时间上对校正后的左心室整体纵向应变没有显著影响（P=0.943）。