Department of Cardiothoracic Surgery, King's College Hospital, London, UK.
Department of Cardiology, King's College Hospital, London, UK.
J Card Surg. 2022 Dec;37(12):4598-4605. doi: 10.1111/jocs.17049. Epub 2022 Oct 25.
In mitral valve replacement (MVR), sudden increases in afterload and disruption of the annular-chordal-papillary-left-ventricular wall causes left ventricular (LV) dysfunction in the early postoperative period. Preservation of the posterior mitral leaflet apparatus (MVR-P) has a favorable outcome on LV function. However, there is paucity of data on the impact of complete preservation of the sub-valvular apparatus (MVR-C).
We investigated the impact of MVR-P and MVR-C on baseline and 3-months postoperative LV ejection fraction (EF) and global longitudinal strain (GLS).
We retrospectively analyzed a cohort of 29 MVR-P and 19 MVR-C patients with complete echocardiography data at our unit, who were operated between 2008 and 2017. Between-group changes in LVEF and GLS were compared using independent sample T-test.
Median age was 59 years (IQR 50-69 years). Baseline LVEF was 58% (51%- 60%). Baseline GLS was -18.4 (-21.2 to -15.5). There were no significant between-group differences between all baseline demographics and echocardiographic markers. There was significantly higher absolute postoperative LVEF in MVR-C patients (p = 0.029). There was also significant worsening in LVEF (p = 0.0121) and GLS (p < 0.0001) after MVR-P and not MVR-C, suggesting no reduction in LV function post-MVR-C but a reduction post-MVR-P. There was significantly less postoperative worsening of GLS per patient in MVR-C group as compared to the MVR-P group (p = 0.023), indicating better preservation of LV function. There was also a smaller decline in LVEF per patient in the MVR-C as compared to the MVR-P group, although not statistically significant (p = 0.23).
MVR with complete preservation of the sub-valvular apparatus shows a favorable impact on the longitudinal function of the heart at 3 months. Further studies with larger patient numbers are indicated to investigate the long-term results of this surgical approach.
在二尖瓣置换术（MVR）中，后负荷的突然增加和瓣环-腱索-乳头肌-左心室壁的破裂会导致术后早期左心室（LV）功能障碍。保留后瓣叶装置（MVR-P）对 LV 功能有良好的效果。然而，关于完整保留瓣下装置（MVR-C）对 LV 功能的影响的数据很少。
我们研究了 MVR-P 和 MVR-C 对基线和术后 3 个月时 LV 射血分数（EF）和整体纵向应变（GLS）的影响。
我们回顾性分析了 2008 年至 2017 年间在我们单位接受完整超声心动图检查的 29 例 MVR-P 和 19 例 MVR-C 患者的队列，比较了两组之间 LVEF 和 GLS 的变化。
中位年龄为 59 岁（IQR 50-69 岁）。基线 LVEF 为 58%（51%-60%）。基线 GLS 为-18.4（-21.2 至-15.5）。两组间所有基线人口统计学和超声心动图标志物均无显著差异。MVR-C 患者术后 LVEF 绝对值明显升高（p=0.029）。MVR-P 后 LVEF（p=0.0121）和 GLS（p<0.0001）均有显著恶化，而 MVR-C 后则无明显恶化，提示 MVR-P 后 LV 功能下降，而 MVR-C 后则无下降。与 MVR-P 组相比，MVR-C 组每个患者术后 GLS 的恶化程度明显较小（p=0.023），表明 LV 功能保存较好。与 MVR-P 组相比，MVR-C 组每个患者的 LVEF 下降幅度也较小，尽管无统计学意义（p=0.23）。
完全保留瓣下装置的二尖瓣置换术在术后 3 个月时对心脏的纵向功能有良好的影响。需要进一步研究以调查这种手术方法的长期结果。
