Cardiovascular Center - Klinik im Park, Zurich, Switzerland.
Heart Care Medical Center, Zurich, Switzerland.
J Cardiovasc Surg (Torino). 2022 Aug;63(4):514-520. doi: 10.23736/S0021-9509.22.12239-1. Epub 2022 May 19.
Patients (pt) with mitral valve prolapse (MVP) due to Barlow disase (BD) have an increased incidence of ventricular arrhythmias (VA; including ventricular tachycardias VT) and sudden cardiac death (SCD). Data on the effect of MV repair on VA are scarce.
Pre- and postoperative VA in severe mitral regurgitation (MR) with MVP due to BD undergoing surgical mitral valve repair were analyzed. Patients with degenerative mitral valve disease not fulfilling BD criteria were excluded. Information was from charts, ECG/Holter ECG and/or pacemaker/ implantable cardioverter defibrillator (ICD) data. SCD, sustained VT>30 sec and/or ventricular fibrillation necessitating an ICD-shock were considered major events. Event probability was calculated using the Kaplan-Meier estimator throughout the follow-up period of 20.7 years.
There were 82 pts (61% males), mean age at surgery 62±14 years. Bileaflet MVP was present in 54%, mitral annular dysjunction (MAD) in 37% and left ventricular ejection fraction (LVEF) <50% in 12%. MV repair included ring annuloplasty in all and artificial chords in 48%. Mean follow-up was 3.1 years (0.2 to 14.2 years). Postoperative rhythm surveillance by Holter ECG and/or pacemaker was available in 67%. A VA load of ≥10% and/or any VT was noted in 26% before and 32% after surgery (P=0.44). Postoperative VA load was not predicted by MAD, artificial chords, LVEF of <50%, age at surgery >50 years and/or residual ≥moderate MR (all P<0.05), it correlated only with bileaflet MVP (P=0.009). Major events occurred in 3 pts: SCD in 2 pts and ICD for sustained polymorphic VT in 1 pt (incidence 1.2%/year). The event probability of receiving a SCD or an ICD-shock was 4.9%.
VA burden does not seem to change after MV repair in MVP due to BD. The occurrence of major arrhythmic events can not be predicted reliably, thus, patients with MVP due to BD may need lifelong postoperative follow-up, especially in bileaflet MVP which was an independent risk factor for increased VA burden in this retrospective long-term study in a small but well selected patient group.
患有巴氏病（Barlow disease，BD）导致二尖瓣脱垂（MVP）的患者，其室性心律失常（VA；包括室性心动过速 VT）和心源性猝死（SCD）的发生率增加。关于 MVP 修复对 VA 的影响的数据很少。
分析了因 BD 导致严重二尖瓣反流（MR）并接受外科二尖瓣修复的 MVP 患者的术前和术后 VA。排除了不符合 BD 标准的退行性二尖瓣疾病患者。信息来自图表、心电图/动态心电图和/或起搏器/植入式心律转复除颤器（ICD）数据。SCD、持续 30 秒以上的持续性 VT 和/或需要 ICD 电击的心室颤动被认为是主要事件。整个 20.7 年的随访期间，使用 Kaplan-Meier 估计器计算事件概率。
共有 82 例患者（61%为男性），手术时的平均年龄为 62±14 岁。双叶 MVP 见于 54%，二尖瓣环分离（MAD）见于 37%，左心室射血分数（LVEF）<50%见于 12%。所有患者均行瓣环成形术，48%患者行人工腱索。平均随访时间为 3.1 年（0.2-14.2 年）。67%的患者术后通过动态心电图和/或起搏器进行节律监测。术前和术后分别有 26%和 32%的患者 VA 负荷≥10%和/或任何 VT（P=0.44）。MAD、人工腱索、LVEF<50%、手术时年龄>50 岁和/或残余中重度 MR 均不能预测术后 VA 负荷（均 P<0.05），仅与双叶 MVP 相关（P=0.009）。3 例患者发生主要事件：2 例心源性猝死，1 例 ICD 治疗持续性多形性 VT（发生率为 1.2%/年）。发生 SCD 或 ICD 电击的事件概率为 4.9%。
在 BD 导致的 MVP 患者中，二尖瓣修复后 VA 负荷似乎没有改变。心律失常事件的发生不能可靠预测，因此，BD 导致 MVP 的患者可能需要终生术后随访，尤其是在双叶 MVP 患者中，在这项回顾性的小但选择良好的患者群体的长期研究中，双叶 MVP 是 VA 负荷增加的独立危险因素。
