Carino Davide, Lorusso Roberto, Del Forno Benedetto, Lapenna Elisabetta, Ascione Guido, Sala Alessandra, Ruggeri Stefania, Schavi Davide, Bargagna Marta, Maisano Francesco, Castiglioni Alessandro, Alfieri Ottavio, De Bonis Michele
Department of Cardiac Surgery, IRCCS San Raffaele Scientific institute, Vita-Salute San Raffaele University, Milan, Italy.
Department of Cardio-Thoracic Surgery, Heart and Vascular Centre, Maastricht University Medical Centre, Maastricht, The Netherlands; Cardiovascular Research Institute Maastricht, Maastricht, The Netherlands.
Ann Thorac Surg. 2023 Jan;115(1):112-118. doi: 10.1016/j.athoracsur.2022.08.008. Epub 2022 Aug 17.
For cases of initial suboptimal mitral valve repair, the edge-to-edge (EE) technique has been used as a bailout procedure. However the long-term durability of those rescued mitral valves is currently unknown. With this study we aim to evaluate the long-term clinical and echocardiographic results of the EE technique used to rescue patients with initial suboptimal conventional mitral valve repair.
A retrospective review of our institutional database was done to query for patients who had undergone mitral valve repair with the EE technique used as a bailout procedure. The cumulative incidence function using death as a competing event was used to estimate cardiac death and redo for mitral valve replacement. To describe the time course of mitral regurgitation, we performed a longitudinal analysis using generalized estimating equations with random intercept for correlated data.
Eighty-one patients were selected. The median follow-up was 9.1 years (interquartile range, 6.7-12.1; maximum, 22.6 years). At 15 years the estimated Kaplan-Meier overall survival was 63.2% ± 8.69% (95% confidence interval, 43.76-77.46) and the predicted rate of moderate to severe mitral regurgitation recurrence was 16.67%. At 15 years the cumulative incidence function for redo for mitral valve replacement with death as a competing event was 2.5% (95% confidence interval, 0.48-7.84). No case of more than mild mitral stenosis was detected.
The EE technique can be effectively used as a bailout procedure in patients with suboptimal conventional mitral valve repair with satisfactory long-term results.
对于初次二尖瓣修复效果欠佳的病例，边对边（EE）技术已被用作补救措施。然而，这些挽救性二尖瓣的长期耐久性目前尚不清楚。通过本研究，我们旨在评估用于挽救初次传统二尖瓣修复效果欠佳患者的EE技术的长期临床和超声心动图结果。
对我们机构数据库进行回顾性查询，以找出接受EE技术作为补救措施进行二尖瓣修复的患者。使用以死亡作为竞争事件的累积发病率函数来估计心源性死亡和二尖瓣置换再次手术的发生率。为了描述二尖瓣反流的时间进程，我们使用具有随机截距的广义估计方程对相关数据进行纵向分析。
共入选81例患者。中位随访时间为9.1年（四分位间距为6.7 - 12.1年；最长22.6年）。15年时，估计的Kaplan-Meier总生存率为63.2% ± 8.69%（95%置信区间为43.76 - 77.46），中度至重度二尖瓣反流复发的预测发生率为16.67%。15年时，以死亡作为竞争事件的二尖瓣置换再次手术的累积发病率函数为2.5%（95%置信区间为0.48 - 7.84）。未检测到超过轻度二尖瓣狭窄的病例。
EE技术可有效用作传统二尖瓣修复欠佳患者的补救措施，长期效果良好。
