Department of Cardiac Surgery, IRCCS San Raffaele Scientific institute, Vita-Salute San Raffaele University, Milan, Italy.
Cardio-Thoracic Surgery Department, Heart and Vascular Centre, Maastricht University Medical Centre, Maastricht, Netherlands.
Eur J Cardiothorac Surg. 2022 Jun 15;62(1). doi: 10.1093/ejcts/ezac135.
Mitral regurgitation (MR) due to commissural prolapse or flail represents a pattern of valve dysfunction that can be treated, among other techniques, by suturing the margins of the anterior and posterior leaflets in the commissural area (commissural closure). The very long-term results of this technique have not been reported so far and represent the objective of this study.
A retrospective review of our institutional database was carried on querying for patients who underwent commissural closure and ring annuloplasty within the time frame 1997-2007 to provide a robust long-term assessment. Cumulative incidence function (CIF) using death as a competitive outcome was used to estimate cardiac death and reoperation for mitral valve replacement. To describe the time course of MR, we performed a longitudinal analysis using generalized estimating equations with a random intercept for correlated data.
A total of 125 patients were included. At 15 years, the CIF for cardiac death, with non-cardiac death as a competitive event, was 8.0 ± 2.57% (95% confidence interval [3.88-13.93]). At 15 years, the CIF for reintervention for a mitral valve replacement with death as a competitive event was 5.0 ± 1.98%, 95% confidence interval [2.04-9.89]. No significant predictors of reintervention for mitral valve replacement were identified. At 5 years, the predicted rate of MR ≥3+ recurrence was 2.53% while it was 8.22% at 15 years. In no case a more than mild mitral stenosis was detected.
Severe MR due to commissural prolapse/flail can be effectively treated with commissural closure and ring annuloplasty. In our series, the rate of reoperation in the very long term was extremely low. Similarly, longitudinal analysis demonstrated a very low rate of MR ≥3+ recurrence.
由于瓣环交界脱垂或连枷导致的二尖瓣关闭不全代表了一种瓣膜功能障碍的模式，可以通过缝合前、后瓣交界区的边缘（交界区闭合）等技术进行治疗。到目前为止，还没有报道这种技术的非常长期结果，这是本研究的目的。
通过查询我们机构数据库中 1997 年至 2007 年期间接受交界区闭合和环形瓣环成形术的患者，进行回顾性分析，以提供可靠的长期评估。使用以死亡为竞争结果的累积发生率函数（CIF）来估计心脏死亡和二尖瓣置换的再次手术。为了描述二尖瓣关闭不全的时间过程，我们使用具有相关数据随机截距的广义估计方程进行了纵向分析。
共纳入 125 例患者。15 年时，以非心脏死亡为竞争事件的心脏死亡 CIF 为 8.0±2.57%（95%置信区间[3.88-13.93]）。15 年时，以死亡为竞争事件的二尖瓣置换再次干预的 CIF 为 5.0±1.98%，95%置信区间[2.04-9.89]。未发现二尖瓣置换再次干预的显著预测因素。5 年时，预测 MR≥3+复发的发生率为 2.53%，15 年时为 8.22%。在任何情况下都未发现中重度二尖瓣狭窄。
交界区脱垂/连枷导致的严重二尖瓣关闭不全可以通过交界区闭合和环形瓣环成形术有效治疗。在我们的系列中，长期再次手术的发生率非常低。同样，纵向分析显示 MR≥3+复发的发生率非常低。
