Department of Cardiology, Houston Methodist DeBakey Heart and Vascular Center, Houston, TX, United States of America.
Department of Medicine, Forrest General Hospital, Hattiesburg, United States of America.
Cardiovasc Revasc Med. 2022 Jul;40:13-19. doi: 10.1016/j.carrev.2021.11.016. Epub 2021 Nov 16.
Incidence of multivalvular heart disease is increasing, with aortic stenosis and mitral regurgitation being the most common. Data are limited on outcomes of patients undergoing multivalvular surgery. The purpose of this study was to evaluate contemporary trends and in-hospital outcomes for combined surgical aortic valve replacement (SAVR) and mitral valve repair (MVr) or replacement (MVR).
We identified patient hospitalizations aged ≥18 years who underwent SAVR + MVr or MVR between 2004 and 2018 using the National Inpatient Sample. Data were weighted to estimate national estimates of the entire US hospitalized population. Exclusion criteria included endocarditis, history of heart transplant or left ventricular assist device, and any other concomitant valve surgery.
Between January 1, 2004, and December 31, 2018, there were 68,882 weighted admissions for SAVR with concomitant mitral valve surgery. Overall, in-hospital mortality was 8.34% with significantly higher inpatient mortality in SAVR + MVR group compared with SAVR + MVr group (9.91% vs 5.57%, p < 0.001). During the study period, adjusted in-hospital mortality decreased in both SAVR + MVr group (p-trend 0.004) and SAVR + MVR group (p-trend <0.001). Age ≥70 years was associated with higher in-hospital mortality compared to those < 70 years (9.95% vs 6.70%, p < 0.001).
Combined aortic and mitral valve surgery is associated with a high risk of in-hospital mortality, especially in patients ≥ 70 years of age. Further research is needed to assess the role of transcatheter approaches in the treatment of multivalvular heart disease.
多瓣膜心脏病的发病率正在增加，其中主动脉瓣狭窄和二尖瓣反流最为常见。关于接受多瓣膜手术的患者的结果数据有限。本研究旨在评估同期行主动脉瓣置换术（SAVR）联合二尖瓣修复（MVr）或置换（MVR）的趋势和住院期间结局。
我们使用国家住院患者样本（National Inpatient Sample），确定了 2004 年至 2018 年期间年龄≥18 岁接受 SAVR+MVr 或 MVR 的患者住院情况。数据经过加权处理，以估计整个美国住院患者人群的全国估计值。排除标准包括心内膜炎、心脏移植或左心室辅助装置病史以及任何其他同时进行的瓣膜手术。
2004 年 1 月 1 日至 2018 年 12 月 31 日，共纳入 68882 例接受 SAVR 联合二尖瓣手术的患者。总的来说，住院死亡率为 8.34%，SAVR+MVR 组的住院死亡率显著高于 SAVR+MVr 组（9.91% vs 5.57%，p<0.001）。在研究期间，SAVR+MVr 组（p 趋势=0.004）和 SAVR+MVR 组（p 趋势<0.001）的调整后住院死亡率均有所下降。与<70 岁的患者相比，年龄≥70 岁的患者住院死亡率更高（9.95% vs 6.70%，p<0.001）。
主动脉瓣和二尖瓣联合手术与较高的住院死亡率相关，尤其是 70 岁以上的患者。需要进一步研究来评估经导管方法在多瓣膜心脏病治疗中的作用。
