Department of Cardiothoracic Surgery, People's Friendship University of Russia (RUDN-University), Moscow, Russia -
Department of Cardiothoracic Surgery, People's Friendship University of Russia (RUDN-University), Moscow, Russia.
J Cardiovasc Surg (Torino). 2022 Aug;63(4):529-535. doi: 10.23736/S0021-9509.22.11874-4.
Engineering of the Carpentier-Edwards Physio (PR-I) and Physio II (PR-II) rings (Edwards Lifesciences Corp., Irvine, CA, USA) combines flexibility with remodeling. PR-II is considered an improvement of PR-I, as it boasts of an improved shape, a double saddle, and a sewing cuff that reduces tension on sutures. Beyond the superior effect of the PR-II on the annular physiology, it has not been proven to be clinically better than the PR-I. This study compares the long-term clinical outcomes of MV repair for degenerative disease with these rings.
From 2004 to 2020, MV repair with Physio ring annuloplasty (group PR-I) was performed in 231 patients, and with Physio-II ring annuloplasty (group PR-II) in 255 patients. A propensity score-matching analysis was used to pair 104 in each group. Primary outcome was recurrent MR≥3 and secondary outcomes were long-term survival, cardiac death, and MV-related events (MVREs). The 15-year follow-up data were complete in 97.3% of patients.
There were no differences in 15-year freedom from recurrent MR (P=0.721), survival and cardiac death between the matched groups (P=0.693 and P=0.135, respectively). MVREs, including cardiac death, pacemaker implantation, thromboembolism, bleeding, and reoperation were also similar between the matched groups (P=0.603). However, 5-year recurrent MR was significantly higher in PR-I than in PR-II (P=0.010). Multivariate analysis showed Barlow's disease and preoperative MR≥3 as risk factors for late MR recurrence.
Type of annuloplasty rings did not influence long-term clinical outcomes. Better annular dynamics seen in PR-II annuloplasty does not translate into superior freedom from recurrent MR.
Carpentier-Edwards Physio（PR-I）和 Physio II（PR-II）环（Edwards Lifesciences Corp.，美国加利福尼亚州欧文）的工程设计结合了柔韧性和重塑性。PR-II 被认为是 PR-I 的改进，因为它具有改进的形状、双鞍座和减少缝线张力的缝合袖口。除了 PR-II 对环形生理学的优越影响外，它在临床上并没有被证明比 PR-I 更好。本研究比较了这些环用于退行性疾病的 MV 修复的长期临床结果。
2004 年至 2020 年，231 例患者接受 Physio 环瓣环成形术（PR-I 组），255 例患者接受 Physio-II 环瓣环成形术（PR-II 组）。使用倾向评分匹配分析对每组中的 104 例进行配对。主要结果是复发性 MR≥3，次要结果是长期生存率、心脏死亡和 MV 相关事件（MVREs）。97.3%的患者完成了 15 年的随访数据。
在匹配组中，15 年无复发性 MR 率（P=0.721）、生存率和心脏死亡率无差异（P=0.693 和 P=0.135）。MVREs，包括心脏死亡、起搏器植入、血栓栓塞、出血和再次手术，在匹配组中也相似（P=0.603）。然而，PR-I 组的 5 年复发性 MR 明显高于 PR-II 组（P=0.010）。多变量分析显示，Barlow 病和术前 MR≥3 是晚期 MR 复发的危险因素。
瓣环成形术的类型并不影响长期临床结果。PR-II 瓣环成形术中看到的更好的环形动力学并不能转化为更高的复发性 MR 无复发率。
