Division of Cardiac Surgery, Li Ka Shing Knowledge Institute of St. Michael's Hospital, Toronto, Ontario, Canada.
Department of Surgery, University of Toronto, Toronto, Ontario, Canada.
Clin Cardiol. 2022 Sep;45(9):921-927. doi: 10.1002/clc.23879. Epub 2022 Jun 24.
Although predictors of reverse left ventricular (LV) remodeling postmitral valve repair are critical for guiding perioperative decision-making, there remains a paucity of randomized, prospective data to support the criteria that potential predictor variables must meet.
The CAMRA CardioLink-2 randomized trial allocated 104 patients to either leaflet resection or preservation strategies for mitral repair. The correlation of indexed left ventricular end-systolic volume (LVESVI), indexed left ventricular end-diastolic volume (LVEDVI), and left ventricular ejection fraction (LVEF) were tested with univariate analysis and subsequently with multivariate analysis to determine independent predictors of reverse remodeling at discharge and at 12 months postoperatively. At discharge, both LVESVI and LVEDVI were independently associated with their preoperative values (p < .001 for both) and LVEF by preoperative LVESVI (p < .001). Mitral ring size was favorably associated with the change in LVESVI (p < .05) and LVEF (p < .01) from predischarge to 12 months, while the mean mitral valve gradient after repair was adversely associated with the change in LVESVI (p < .05) and LVEDVI (p < .05). No significant associations were found between reverse remodeling and coaptation height nor mitral repair technique.
Beyond confirming the lack of impact of mitral repair technique on reverse remodeling, this investigation suggests that recommending surgery before significant LV dilatation or dysfunction, as well as higher postoperative mitral valve hemodynamic performance, may enhance remodeling capacity following mitral repair.
尽管预测二尖瓣修复术后左心室（LV）逆重构的因素对于指导围手术期决策至关重要，但仍缺乏随机、前瞻性数据来支持潜在预测变量必须满足的标准。
CAMRA CardioLink-2 随机试验将 104 例患者随机分配至二尖瓣修复的瓣叶切除术或保留策略。通过单变量分析和随后的多变量分析，对左心室收缩末期容积指数（LVESVI）、左心室舒张末期容积指数（LVEDVI）和左心室射血分数（LVEF）进行相关性检验，以确定术后出院和 12 个月时逆重构的独立预测因素。出院时，LVESVI 和 LVEDVI 均与术前值独立相关（两者均 < .001），而术前 LVESVI 与 LVEF 独立相关（ < .001）。二尖瓣环大小与 LVESVI 的变化呈正相关（p < .05）和 LVEF（p < .01）从出院前到 12 个月，而修复后的平均二尖瓣瓣口梯度与 LVESVI 的变化呈负相关（p < .05）和 LVEDVI（p < .05）。在逆重构与瓣叶对合高度或二尖瓣修复技术之间未发现显著相关性。
除了确认二尖瓣修复技术对逆重构没有影响外，本研究还表明，在 LV 扩张或功能障碍显著之前建议手术，以及术后二尖瓣血流动力学性能更高，可能会增强二尖瓣修复后的重构能力。
