Masuzawa Akihiro, Takagi Tomomitsu, Arai Hirokuni, Matsumiya Goro, Takanashi Shuichiro, Yaku Hitoshi, Komiya Tatsuhiko, Matsui Yoshiro, Wakasa Satoru, Kunihara Takashi
Department of Cardiac Surgery, The Jikei University School of Medicine, Tokyo, Japan.
Department of Cardiothoracic Surgery, Tokyo Medical and Dental University Graduate School of Medicine, Tokyo, Japan.
Ann Thorac Cardiovasc Surg. 2022 Feb 20;28(1):56-62. doi: 10.5761/atcs.oa.21-00048. Epub 2021 Aug 2.
Mitral subvalvular procedures in addition to restrictive annuloplasty are promising for ischemic mitral regurgitation (IMR). However, the prevalence and efficacy of specific subvalvular repair in severe IMR have not been elucidated. This is the first nationwide survey regarding surgeons' attitudes toward IMR in Japan.
A questionnaire was sent to 543 institutions. From 2015 to 2019, numbers of elective first-time mitral valve replacement (MVR) with/without complete chordal preservation (CCP)/papillary muscle approximation (PMA) and mitral valvuloplasty (MVP) with/without papillary muscle relocation (PMR)/PMA in patients with severe IMR were collected. Concomitant procedures for coronary artery, tricuspid valve, and arrhythmia could be included but left ventricular reconstruction was excluded.
Completed questionnaires were received from 286 institutions (52.7%). The majority (90%) had less than 20 cases within 5 years. The number of MVP (1413, 61.5%) surpassed MVR (886, 38.5%). CCP was performed in half of MVR (50.0%), while PMA was included in only 1.9% of MVR. PMA and PMR were also performed infrequently, in only 7.7% and 10.9% of MVP, respectively.
Japanese surgeons aggressively perform MVP for severe IMR. Subvalvular repair was also aggressively performed in addition to MVR, but not to MVP. A multicenter registry study is in progress.
除限制性瓣环成形术外，二尖瓣瓣下手术对缺血性二尖瓣反流（IMR）具有前景。然而，严重IMR中特定瓣下修复的发生率和疗效尚未阐明。这是日本首次针对外科医生对IMR态度的全国性调查。
向543家机构发送了调查问卷。收集2015年至2019年期间重度IMR患者首次择期二尖瓣置换术（MVR）伴/不伴完全腱索保留（CCP）/乳头肌靠拢（PMA）以及二尖瓣成形术（MVP）伴/不伴乳头肌移位（PMR）/PMA的例数。冠状动脉、三尖瓣和心律失常的同期手术可纳入，但左心室重建被排除。
共收到286家机构（52.7%）填写完整的问卷。大多数机构（90%）在5年内病例数少于20例。MVP的例数（1413例，61.5%）超过MVR（886例，38.5%）。MVR中有一半（50.0%）进行了CCP，而MVR中仅1.9%进行了PMA。PMA和PMR的实施频率也较低，分别仅占MVP的7.7%和10.9%。
日本外科医生积极对重度IMR实施MVP。除MVR外，瓣下修复也积极开展，但MVP中未积极开展。一项多中心注册研究正在进行中。
