Department of Surgery, Keck School of Medicine of USC, University of Southern California, Los Angeles, California, USA.
Department of Preventive Medicine, Keck School of Medicine of USC, University of Southern California, Los Angeles, California, USA.
J Card Surg. 2021 Aug;36(8):2636-2643. doi: 10.1111/jocs.15586. Epub 2021 Apr 28.
Debate continues in regard to the optimal surgical approach to the mitral valve for degenerative disease.
Between February 2004 and July 2015, 363 patients underwent mitral valve repair for degenerative mitral valve disease via either sternotomy (sternotomy, n = 109) or small right anterior thoracotomy (minimally invasive, n = 259). Survival, need for mitral valve reoperation, and progression of mitral regurgitation more than two grades were compared between cohorts using time-based statistical methods and inverse probability weighting.
Survival at 1, 5, and 10 years were 99.2, 98.3, and 96.8 for the sternotomy group and 98.1, 94.9, and 94.9 for the minimally invasive group (hazard ratio: 0.39, 95% confidence interval [CI] 0.11-1.30, p = .14). The cumulative incidence of need for mitral valve reoperation with death as a competing outcome at 1, 3, and 5 years were 2.7%, 2.7%, and 2.7% in the sternotomy cohort and 1.5%, 3.3%, and 4.1% for the minimally invasive group (subhazard ratio (SHR) 1.17, 95% CI: 0.33-4.20, p = .81). Cumulative incidence of progression of mitral regurgitation more than two grades with death as a competing outcome at 1, 3, and 5 years were 5.5%, 14.4%, and 44.5% for the sternotomy cohort and 4.2%, 9.7%, and 20.5% for the minimally invasive cohort (SHR: 0.67, 95% CI: 0.28-1.63, p = .38). Inverse probability weighted time-based analyses based on preoperative cohort assignment also demonstrated equivalent outcomes between surgical approaches.
Minimally invasive and sternotomy mitral valve repair in patients with degenerative mitral valve disease is associated with equivalent survival and repair durability.
对于退行性心脏瓣膜疾病的二尖瓣手术方法，仍存在争议。
2004 年 2 月至 2015 年 7 月，363 例行二尖瓣修复术的退行性二尖瓣疾病患者，其中 109 例行胸骨切开术（胸骨切开术组），259 例行小右前开胸术（微创组）。采用基于时间的统计方法和逆概率加权法比较两组患者的生存情况、二尖瓣再手术的需要及二尖瓣反流加重两个等级以上的情况。
胸骨切开术组和微创组的 1 年、5 年和 10 年生存率分别为 99.2%、98.3%和 96.8%，98.1%、94.9%和 94.9%（风险比：0.39，95%置信区间[CI]0.11-1.30，p=0.14）。胸骨切开术组与微创组的 1 年、3 年和 5 年因死亡而竞争的二尖瓣再手术累积发生率分别为 2.7%、2.7%和 2.7%，1.5%、3.3%和 4.1%（亚危险比（SHR）1.17，95%CI：0.33-4.20，p=0.81）。胸骨切开术组和微创组的 1 年、3 年和 5 年因死亡而竞争的二尖瓣反流加重两个等级以上的累积发生率分别为 5.5%、14.4%和 44.5%和 4.2%、9.7%和 20.5%（SHR：0.67，95%CI：0.28-1.63，p=0.38）。基于术前队列分配的逆概率加权基于时间的分析也表明两种手术方法的结果相当。
退行性二尖瓣疾病患者行微创二尖瓣修复术和胸骨切开术修复术的生存率和修复耐久性相当。
