Department of cardiothoracic Surgery, Baylor Scott and White Health, Temple, TX, 76508, USA.
Départment of Cardiothoracic and Vascular Surgery, Mayo Clinic, 4500 San Pablo Rd S, Jacksonville, FL, 32224, USA.
Gen Thorac Cardiovasc Surg. 2022 Oct;70(10):850-861. doi: 10.1007/s11748-022-01822-6. Epub 2022 May 6.
Current evidence does not allow a consensus on the management of moderate chronic ischemic mitral regurgitation (CIMR). We compared moderate CIMR patients undergoing off-pump CABG (OPCABG) alone and CABG + MV repair for early mortality, major adverse systemic events (MASE) and mid-term functional outcomes.
210 patients with moderate CIMR who underwent off-pump coronary artery bypass grafting (OPCABG) Group I (n = 106) or CABG + mitral valve repair (MV rep) Group II (n = 104) were followed prospectively. For comparison, patients were further sub-divided based on the product of regurgitant fraction and ejection fraction "RFEF"(Good/Bad) and MR jet direction (Central/Eccentric). The primary end point of the study was mortality and secondary end points were MASE, percentage improvements in indexed left ventricle end-systolic volume (LVESVI %), MR grade and functional outcomes of the patients.
In-hospital and overall mortality was significantly lower in Group I (1.89% vs. 13.46%, p < 0.001 and 5.66% vs. 15.38%; p = 0.024 respectively). Group II had significantly higher MASE, ventilation time, mean ICU and hospital stay. At 36 months, LVESVI% (17.56% ± 9.12% vs. 18.81% ± 7.48%; p = 0.279), MR grade improvement (80.18% vs. 83.50%; p = 0.544), NYHA class and MLHF scores were also similar in both groups. On subgroup analysis, Good RFEF with Central jet subgroup had comparable improvement in LVESVI% and MR grade with either procedure, while Bad Eccentric subgroup showed a significantly higher improvement in LVESVI% and MR grade with CABG + MV repair.
OPCABG is associated with significantly reduced mortality and MASE with comparable improvement in LVEDVI% and MR grade. CABG + MV Rep results in significant improvement in LVEDVI% and MR grade in patients with bad eccentric MR. The recommended procedures in the "Good Central" and "Bad Eccentric" subsets are CABG and CABG + Mvrepair, respectively.
目前尚无共识可以指导中度慢性缺血性二尖瓣反流（CIMR）的处理。我们比较了单纯非体外循环冠状动脉旁路移植术（OPCABG）和冠状动脉旁路移植术（CABG）+二尖瓣修复术（MV 修复）治疗中度 CIMR 的早期死亡率、主要不良全身事件（MASE）和中期功能结局。
前瞻性随访 210 例中度 CIMR 患者，分为单纯 OPCABG 组 I（n=106）和 CABG+MV 修复组 II（n=104）。为了比较，根据反流分数和射血分数的乘积（RFEF）“好/差”和 MR 射流方向（中心/偏心），将患者进一步分为亚组。该研究的主要终点是死亡率，次要终点是 MASE、左心室收缩末期容积指数（LVESVI%）改善百分比、MR 分级和患者的功能结局。
组 I 的院内和总死亡率明显低于组 II（1.89%比 13.46%，p<0.001；5.66%比 15.38%，p=0.024）。组 II 的 MASE、通气时间、平均 ICU 和住院时间明显较高。在 36 个月时，LVESVI%（17.56%±9.12%比 18.81%±7.48%，p=0.279）、MR 分级改善（80.18%比 83.50%，p=0.544）、NYHA 心功能分级和 MLHF 评分在两组间也相似。亚组分析显示，中心射流的 RFEF 良好亚组与任何一种手术的 LVESVI%和 MR 分级改善相当，而偏心射流的 RFEF 不良亚组的 LVESVI%和 MR 分级改善明显较高。
OPCABG 与死亡率和 MASE 的显著降低相关，LVESVI%和 MR 分级的改善相当。CABG+MV 修复可显著改善偏心性 MR 患者的 LVESVI%和 MR 分级。“好的中心”和“坏的偏心”亚组的推荐手术分别为 CABG 和 CABG+MV 修复。
