Clinic for Cardiac Surgery, Asklepios Klinikum Harburg, Hamburg, Germany.
Clinic for Cardiovascular Surgery, MediClin Heart Center Coswig, Coswig (Anhalt), Germany.
J Thorac Cardiovasc Surg. 2024 Mar;167(3):957-964. doi: 10.1016/j.jtcvs.2022.07.032. Epub 2022 Aug 6.
Degeneration of mitral prostheses/rings may be treated by redo surgery, and, recently, by transcatheter valve-in-valve/ring implantation. This multicenter registry presents results of transcatheter valve-in-valve and repeat surgery for prostheses/rings degeneration.
Data provided by 10 German heart centers underwent propensity score-matched retrospective analysis. The primary endpoint was 30-day/midterm mortality. Perioperative outcome was assessed according to the Mitral Valve Academic Research Consortium criteria. Further, the influence of moderate or greater tricuspid regurgitation (TR) on 30-day/midterm mortality was analyzed.
Between 2014 and 2019, 273 patients (79 transcatheter mitral valve-in-valve [TM-ViV] and 194 redo mitral valve replacement [Re-MVR]) underwent repeat procedure for mitral prosthesis/ring degeneration. Propensity score matching distinguished 79 patient pairs. European System for Cardiac Operative Risk Evaluation (EuroSCORE) II-predicted risk was 15.7 ± 13.7% in the TM-ViV group and 15.0% ± 12.7% in the Re-MVR group (P = .5336). TM-ViV patients were older (74.73 vs 72.2 years; P = .0030) and had higher incidence of atrial fibrillation (54 vs 40 patients; P = .0233). Severe TR incidence was similar (17.95% in TM-ViV vs 14.10%; P = .1741). Sixty-eight TM-ViV patients previously underwent mitral valve replacement, whereas 41 Re-MVR patients underwent valve repair (P < .0001). Stenosis was the leading degeneration mechanism in 42 TM-ViV versus 22 Re-MVR patients (P < .0005). The 30-day/midterm mortality did not differ between groups. Moderate or greater TR was a predictor of total (odds ratio [OR], 4.36; P = .0011), 30-day (OR, 3.76; P = .0180), and midterm mortality (OR, 4.30; P = .0378), irrespective of group.
In both groups, observed mortality was less than predicted. Redo surgery enabled treatment of concomitant conditions, such as atrial fibrillation or TR. TR was shown to be a predictor of total, 30-day, and midterm mortality in both groups.
二尖瓣假体/环的退行性变可以通过再次手术治疗，最近也可以通过经导管瓣中瓣/环植入术治疗。该多中心登记研究报告了经导管瓣中瓣和再次手术治疗假体/环退行性变的结果。
10 家德国心脏中心提供的数据进行了倾向评分匹配的回顾性分析。主要终点为 30 天/中期死亡率。根据二尖瓣学术研究联合会（Mitral Valve Academic Research Consortium，MVARC）标准评估围手术期结果。此外，还分析了中度或重度三尖瓣反流（TR）对 30 天/中期死亡率的影响。
2014 年至 2019 年间，273 例（79 例经导管二尖瓣瓣中瓣[TM-ViV]和 194 例再次二尖瓣置换术[Re-MVR]）因二尖瓣假体/环退行性变接受了重复手术。倾向评分匹配区分了 79 对患者。TM-ViV 组的欧洲心脏手术风险评估系统（European System for Cardiac Operative Risk Evaluation，EuroSCORE）Ⅱ预测风险为 15.7±13.7%，Re-MVR 组为 15.0%±12.7%（P=0.5336）。TM-ViV 患者年龄更大（74.73 岁比 72.2 岁；P=0.0030），心房颤动发生率更高（54 例比 40 例；P=0.0233）。严重 TR 的发生率相似（TM-ViV 为 17.95%，Re-MVR 为 14.10%；P=0.1741）。68 例 TM-ViV 患者此前接受了二尖瓣置换术，而 41 例 Re-MVR 患者接受了瓣膜修复术（P<0.0001）。TM-ViV 组 42 例和 Re-MVR 组 22 例患者的主要退行性变机制为狭窄（P<0.0005）。30 天/中期死亡率在两组间无差异。中度或重度 TR 是总死亡率（优势比[OR]，4.36；P=0.0011）、30 天死亡率（OR，3.76；P=0.0180）和中期死亡率（OR，4.30；P=0.0378）的预测因素，与组无关。
两组的观察死亡率均低于预测死亡率。再次手术可治疗心房颤动或 TR 等合并症。TR 是两组总死亡率、30 天死亡率和中期死亡率的预测因素。
