Morisaki Akimasa, Takahashi Yosuke, Fujii Hiromichi, Sakon Yoshito, Murakami Takashi, Shibata Toshihiko
Department of Cardiovascular Surgery, Osaka City University Graduate School of Medicine, 1-4-3 Asahimachi, Abeno-ku, Osaka, 545-8585, Japan.
Department of Cardiovascular Surgery, Osaka City General Hospital, Osaka, Japan.
Gen Thorac Cardiovasc Surg. 2022 Sep;70(9):793-803. doi: 10.1007/s11748-022-01804-8. Epub 2022 Mar 29.
We assessed the long-term outcomes of the loop technique with ring annuloplasty for mitral regurgitation from our > 10-year experience.
We retrospectively reviewed 362 patients who underwent the loop technique with ring annuloplasty via median sternotomy or right mini-thoracotomy for mitral regurgitation. The median follow-up duration was 4.1 years (interquartile range 2.3-5.8 years).
This study involved 147 women and 215 men (median age, 66.5 years). Mitral regurgitation was caused by Barlow's disease in 27 patients. Seven patients required reoperations (recurrent regurgitation caused by technical issues, n = 3; progression of degenerative disease, n = 4). The 5- and 10-year cumulative incidences of reoperation considering death as the competing event were 1.4% and 5.4%, respectively. The 5- and 10-year postoperative cumulative incidences of moderate-to-severe recurrent mitral regurgitation were 4.7% and 13.0%, respectively. Residual regurgitation ≥ mild (hazard ratio, 6.99; 95% confidence interval, 1.520-32.12; P = .012) was an independent risk factor for reoperation. The independent risk factors for moderate-to-severe recurrent regurgitation were residual regurgitation ≥ mild (hazard ratio, 9.60; 95% confidence interval, 3.042-30.31; P < .001) and the loop-in-loop technique (hazard ratio, 3.40; 95% confidence interval, 1.058-10.90; P = .040). The median mean pressure gradient was sustained at almost 3.5 mmHg for > 7 years.
The loop technique with ring annuloplasty provided excellent results with good hemodynamics beyond the mid-term. Residual regurgitation ≥ mild and the loop-in-loop technique may not be preferable for durable outcomes.
根据我们超过10年的经验，评估采用瓣环成形环技术治疗二尖瓣反流的长期疗效。
我们回顾性分析了362例因二尖瓣反流接受经正中胸骨切开术或右胸小切口进行瓣环成形环技术治疗的患者。中位随访时间为4.1年（四分位间距2.3 - 5.8年）。
本研究纳入147例女性和215例男性（中位年龄66.5岁）。27例患者的二尖瓣反流由巴洛病引起。7例患者需要再次手术（因技术问题导致复发性反流3例；退行性疾病进展4例）。将死亡视为竞争事件时，再次手术的5年和10年累积发生率分别为1.4%和5.4%。术后中度至重度复发性二尖瓣反流的5年和10年累积发生率分别为4.7%和13.0%。残余反流≥轻度（风险比，6.99；95%置信区间，1.520 - 32.12；P = 0.012）是再次手术的独立危险因素。中度至重度复发性反流的独立危险因素为残余反流≥轻度（风险比，9.60；95%置信区间，3.042 - 30.31；P < 0.001）和环中环技术（风险比，3.40；95%置信区间，1.058 - 10.90；P = 0.040）。中位平均压力阶差在超过7年的时间里几乎维持在3.5 mmHg。
瓣环成形环技术在中期以后提供了良好的血流动力学效果。残余反流≥轻度和环中环技术对于获得持久疗效可能并非首选。
