Division of Cardiac Surgery, University of Padova, Padova, Italy.
Division of Anesthesiology, University of Padova, Padova, Italy.
Interact Cardiovasc Thorac Surg. 2022 Jun 15;35(1). doi: 10.1093/icvts/ivac053.
Transapical Neochordae implantation (NC) allows beating heart mitral valve repair in patients with degenerative mitral regurgitation. The aim of this single-centre, retrospective study was to compare outcomes of NC versus conventional surgical (CS) mitral valve repair.
Data of patients who underwent isolated mitral valve repair with NC or CS from January 2010 to December 2018 were collected. A propensity score matching analysis was performed to reduce confounding due to baseline differences between groups. The primary end point was overall all-cause mortality; secondary end points were freedom from reoperation, freedom from moderate (2+) and from severe (3+) mitral regurgitation (MR) and New York Heart Association functional class in the overall population and in patients with isolated P2 prolapse (type A anatomy).
Propensity analysis selected 88 matched pairs. There was no 30-day mortality in the 2 groups. Kaplan-Meier analysis showed similar 5-year survival in the 2 groups. Patients undergoing NC showed worse freedom from moderate MR (≥2+) (57.6% vs 84.6%; P < 0.001) and from severe MR (3+) at 5-year follow-up: 78.1% vs 89.7% (P = 0.032). In patients with type A anatomy, freedom from moderate MR and from severe MR was similar between groups (moderate: 63.9% vs 74.6%; P = 0.21; severe: 79.3% vs 79%; P = 0.77 in NC and FS, respectively). Freedom from reoperation was lower in the NC group: 78.9% vs 92% (P = 0.022) but, in type A patients, it was similar: 79.7% and 85% (P = 0.75) in the NC and CS group, respectively. More than 90% of patients of both groups were in New York Heart Association class I and II at follow-up.
Transapical beating-heart mitral chordae implantation can be considered as an alternative treatment to CS, especially in patients with isolated P2 prolapse.
经心尖植入人工腱索（NC）可在退行性二尖瓣反流患者行心脏不停跳二尖瓣修复术。本单中心回顾性研究旨在比较 NC 与传统外科手术（CS）二尖瓣修复术的结果。
收集 2010 年 1 月至 2018 年 12 月期间行单纯二尖瓣修复术的患者，分别采用 NC 或 CS 治疗的数据。采用倾向评分匹配分析以减少组间基线差异引起的混杂因素。主要终点是全因总死亡率；次要终点是总体人群和单纯 P2 脱垂（A型解剖）患者的无再手术、无中度（2+）和重度（3+）二尖瓣反流（MR）以及纽约心脏协会心功能分级的无事件生存率。
倾向性分析选择了 88 对匹配组。两组均无 30 天死亡率。Kaplan-Meier 分析显示两组 5 年生存率相似。NC 组患者中度 MR（≥2+）（57.6% vs 84.6%；P < 0.001）和重度 MR（3+）的无事件生存率更差（78.1% vs 89.7%；P = 0.032）。在 A 型解剖结构患者中，两组中度和重度 MR 的无事件生存率相似（中度：63.9% vs 74.6%；P = 0.21；重度：79.3% vs 79%；P = 0.77）。NC 组的再手术率较低：78.9% vs 92%（P = 0.022），但在 A 型患者中，NC 组和 CS 组的再手术率相似：79.7%和 85%（P = 0.75）。两组患者在随访时均有超过 90%的患者处于纽约心脏协会心功能 I 级和 II 级。
经心尖心脏不停跳二尖瓣腱索植入术可作为 CS 的替代治疗方法，尤其是在单纯 P2 脱垂患者中。
