Division of Cardiothoracic Surgery, Department of Surgery, Duke University Medical Center, Durham, North Carolina, USA.
Division of Cardiology, Department of Medicine, Duke University Medical Center, Durham, North Carolina, USA.
J Card Surg. 2022 Feb;37(2):290-296. doi: 10.1111/jocs.16094. Epub 2021 Oct 19.
The durability of surgical repair for degenerative versus ischemic mitral regurgitation (MR) is thought to be markedly different. We, therefore, examined late outcomes and durability for mitral repair in a large cohort of patients receiving a single annuloplasty device.
A total of 749 consecutive patients receiving mitral repair for degenerative mitral regurgitation (DMR) or ischemic mitral regurgitation (IMR) were evaluated from a prospective database. Patients with tricuspid or maze surgery were included. Papillary muscle rupture and mixed valve etiologies were excluded. Outcomes were compared for IMR versus DMR.
Patients with DMR were younger and less urgent. Patients with IMR had mean end-systolic diameter 4.5 ± 1.1 cm. All patients received the same complete semirigid annuloplasty device with median ring size 32 mm for DMR and 24 mm for IMR. New York Heart Association failure class improved from 2.8 to 1.5 (p < .001). Patients with DMR had lower operative mortality (1/384 [0.3%] vs. 26/365 [7%], p < .0001) and shorter length of stay. A 15-year survival was better with DMR (63% ± 3% vs. 13% ± 2%, p < .001). At 10 years, the incidence of recurrent ≥2+ MR (10% ± 2% vs. 16% ± 2%, p = .16) was not significantly different. Predictors of recurrent ≥2+ MR were female gender (odds ratio [OR]: 3.0 (1.9-4.8, p < .0001), and prior operation (OR: 2.4 [1.3-4.5], p = .02) but not IMR (OR: 1.4 [0.9-2.3], p = .15).
In this series, where patients with IMR had relatively preserved ventricular dimensions, the primary determinants of late recurrent MR were female gender and prior operation but not IMR versus DMR. Selected patients with IMR can obtain relatively durable mitral repair despite higher operative risk and lower survival compared to DMR.
退行性与缺血性二尖瓣反流（MR）的手术修复耐久性被认为有显著差异。因此，我们在接受单一瓣环成形术装置治疗的大量患者中检查了二尖瓣修复的晚期结果和耐久性。
从前瞻性数据库中评估了 749 例连续接受退行性二尖瓣反流（DMR）或缺血性二尖瓣反流（IMR）二尖瓣修复的患者。包括三尖瓣或迷宫手术的患者。排除乳头肌破裂和混合瓣膜病因。比较 IMR 与 DMR 的结果。
DMR 患者更年轻且病情不紧急。IMR 患者的平均收缩末期直径为 4.5±1.1cm。所有患者均接受相同的完全半刚性瓣环成形术装置，DMR 的中位环大小为 32mm，IMR 的为 24mm。纽约心脏协会心功能衰竭分级从 2.8 级改善至 1.5 级（p<.001）。DMR 患者的手术死亡率较低（1/384[0.3%]与 26/365[7%]，p<.0001），住院时间较短。DMR 患者的 15 年生存率更高（63%±3%与 13%±2%，p<.001）。10 年时，≥2+MR 复发的发生率（10%±2%与 16%±2%，p=0.16）无显著差异。≥2+MR 复发的预测因素为女性（优势比[OR]：3.0（1.9-4.8，p<.0001））和既往手术（OR：2.4（1.3-4.5），p=0.02），而非 IMR（OR：1.4（0.9-2.3），p=0.15）。
在本系列中，IMR 患者的心室尺寸相对保留，晚期复发性 MR 的主要决定因素是女性和既往手术，但不是 IMR 与 DMR。尽管手术风险较高且生存率较低，但与 DMR 相比，选定的 IMR 患者仍可获得相对持久的二尖瓣修复。
