Department of Cardiology, Sakakibara Heart Institute, Tokyo, Japan; Department of Cardiovascular Medicine, Chiba University Graduate School of Medicine, Chiba, Japan.
Department of Cardiology, Sakakibara Heart Institute, Tokyo, Japan.
Heart Lung Circ. 2021 Sep;30(9):1414-1421. doi: 10.1016/j.hlc.2021.03.269. Epub 2021 Apr 16.
Long-term predictors of recurrent mitral regurgitation (MR) after mitral valve plasty (MVP) remain to be elucidated. This study sought to determine the prognostic factors of recurrent MR during long-term follow-up after MVP, by analysing findings of three-dimensional transoesophageal echocardiography (TEE) conducted after MVP.
This study analysed 207 patients who underwent MVP for A2 and/or P2 prolapse and received TEE before discharge. Recurrent MR was defined as moderate or worse regurgitation detected by annual transthoracic echocardiography.
During a median follow-up period of 49 months after MVP, 18 patients experienced recurrent MR and six patients needed reoperation. In the recurrent group, 16 of 18 patients showed less than moderate MR before discharge. Patients in the recurrent group underwent repair for worse MR (effective orifice area, 54±19 vs 44±16 mm; p=0.01) and had shorter A2-P2 coaptation length (5.3±1.4 vs 7.3±1.5 mm; p<0.001) after MVP compared with the non-recurrent group. Cox proportional hazards regression analysis identified the A2-P2 coaptation length as significant risk of recurrent MR (coaptation length increase: HR, 0.44; 95% CI, 0.32-0.59; p<0.0001). The receiver operator characteristics curve demonstrated that a coaptation length of <5.6 mm had 78% sensitivity and 89% specificity for predicting recurrent MR.
Coaptation length measured by post-MVP TEE predicted the tendency of recurrent MR. Patients with short coaptation length should be carefully monitored, even when residual MR is less than moderate after MVP.
二尖瓣成形术后（MVP）后复发性二尖瓣反流（MR）的长期预测因素仍有待阐明。本研究旨在通过分析 MVP 后进行的三维经食管超声心动图（TEE）检查结果，确定 MVP 后长期随访期间复发性 MR 的预测因素。
本研究分析了 207 例因 A2 和/或 P2 脱垂而行 MVP 并在出院前接受 TEE 检查的患者。复发性 MR 定义为通过年度经胸超声心动图检测到中度或更严重的反流。
在 MVP 后中位数为 49 个月的随访期间，18 例患者出现复发性 MR，6 例患者需要再次手术。在复发性组中，18 例患者中有 16 例在出院前显示为小于中度 MR。与非复发性组相比，复发性组患者因更严重的 MR 而行修复术（有效瓣口面积，54±19 比 44±16mm；p=0.01），并且 MVP 后 A2-P2 对合长度更短（5.3±1.4 比 7.3±1.5mm；p<0.001）。Cox 比例风险回归分析确定 A2-P2 对合长度是复发性 MR 的显著危险因素（对合长度增加：HR，0.44；95%CI，0.32-0.59；p<0.0001）。受试者工作特征曲线表明，<5.6mm 的对合长度对预测复发性 MR 具有 78%的敏感性和 89%的特异性。
MVP 后 TEE 测量的对合长度预测了复发性 MR 的倾向。即使 MVP 后残余 MR 小于中度，对合长度较短的患者也应密切监测。
