Department of Cardiovascular Surgery, Osaka City University Graduate School of Medicine, Osaka, Japan.
Department of Cardiology, Osaka City General Hospital, Osaka, Japan.
J Card Surg. 2021 Dec;36(12):4485-4496. doi: 10.1111/jocs.15985. Epub 2021 Sep 19.
Our study aims to examine the midterm outcomes of the loop technique for extended mitral valve (MV) prolapse patients.
From October 2008 to August 2020, we performed MV repairs in 407 patients with severe mitral regurgitation (MR). Follow-up ranged in duration from 287 to 2899 days (median, 872 days). The prolapse extensiveness (p-score) was determined based on the ratio of prolapsing segment's areas to whole area. We divided the whole MV into 10 segments (A1, A2 medial, A2 lateral, A3, P1, P2 medial, P2 lateral, P3, AC, and PC). Patients were categorized into three groups according to the p-score: simple (0.1-0.2), intermediate (0.3-0.4), and extensive (0.5-0.9).
All patients underwent MV repair with the loop technique. The rates of freedom from significant (moderate to severe or severe) MR at 5 and 7 years after surgery were 91% and 91%, respectively. There were 252, 115, and 40 patients in simple group, intermediate group, and extensive group, respectively. The following were significantly increased in extended group: Barlow disease (23/40 patients, p < .001), the number of loops (p for trend < .0001), and the technique score (p for trend < .0001). The rates of freedom from significant MR at 7 years after surgery were 92% in simple group, 87% in intermediate group, and 94% in extended group, respectively (p = .995). Receiver-operating characteristic curves showed a postoperative mild MR with a sensitivity of 86% and a specificity of 68% for predicting significant MR recurrence.
MV repair using the loop technique was useful even in groups with extended prolapse.
本研究旨在探讨 Loop 技术治疗二尖瓣（MV）延长性脱垂患者的中期结果。
2008 年 10 月至 2020 年 8 月，我们对 407 例严重二尖瓣反流（MR）患者进行了 MV 修复。随访时间为 287 至 2899 天（中位数为 872 天）。根据脱垂节段面积与整个面积的比值确定脱垂延伸程度（p 评分）。我们将整个 MV 分为 10 个节段（A1、A2 内侧、A2 外侧、A3、P1、P2 内侧、P2 外侧、P3、AC 和 PC）。根据 p 评分，患者分为三组：简单组（0.1-0.2）、中度组（0.3-0.4）和广泛组（0.5-0.9）。
所有患者均采用 Loop 技术行 MV 修复。术后 5 年和 7 年无重度（中度至重度或重度）MR 的生存率分别为 91%和 91%。简单组、中度组和广泛组分别有 252、115 和 40 例患者。扩展组中以下情况明显增加：巴洛病（40 例患者中有 23 例，p<0.001）、环数（p 趋势<0.0001）和技术评分（p 趋势<0.0001）。术后 7 年无重度 MR 的生存率分别为简单组 92%、中度组 87%和广泛组 94%（p=0.995）。ROC 曲线显示术后轻度 MR 预测重度 MR 复发的敏感性为 86%，特异性为 68%。
即使在延长性脱垂组中，Loop 技术行 MV 修复也是有用的。
