Fujian Medical University, Fuzhou, 350001, Fujian, People's Republic of China.
Department of Cardiovascular Surgery, Union Hospital, Fujian Medical University, Fuzhou, 350001, Fujian, People's Republic of China.
BMC Cardiovasc Disord. 2022 Dec 17;22(1):551. doi: 10.1186/s12872-022-03010-z.
To compare the early and late postoperative outcomes of chordal reconstruction (CR) and quadrangular resection (QR) in patients with posterior mitral valve prolapse (PMPL).
Between January 2008 and December 2018, 305 patients with PMPL who underwent mitral valve plasty (MVP) were included in this retrospective analysis. The CR and QR procedures were performed in 169 patients (CR group) and 136 patients (QR group), respectively. Early and late postoperative outcomes were compared between the groups.
Follow-up was complete in 96.4% (294/305) of patients, with a mean follow-up of 81.2 ± 30.4 months. No 30-day mortality was observed in any of the patients. The success rate of the mitral valve repair was similar in both groups (99.4% vs. 98.5%, P = 0.850). The incidence of early postoperative hemolysis was lower in the CR group than in the QR group (0.00% vs. 3.0%, P = 0.024). Postoperative left ventricular end-diastolic diameter (LVEDD) decreased more significantly in the CR group than in the QR group at 3 months (8.15 [1.30,12.65] vs. 3.25 [- 0.05, 8.75] mm, P < 0.001). During follow-up, the overall survival rates were 95.1% and 94.6% in the CR and QR groups, respectively. The incidence of reoperation for moderate or severe mitral regurgitation (MR) was similar in both groups (4.3% vs.5.4%, P = 0.653), but the time interval between the initial operation and reoperation was shorter in the QR group than in the CR group (84.3 ± 36.1 vs. 120.9 ± 27.6 months, P = 0.026). The LVEDD enlargement was more significant in the QR group than in the CR group (4.5 [3.6, 4.5] vs. 2.4 [1.3, 2.8] mm, P < 0.001).
CR and QR are effective techniques for patients with PMPL. Both techniques resulted in a low incidence of recurrent MR. However, CR can reduce early postoperative hemolysis and LVEDD more significantly. During the long-term follow-up, reoperations due to recurrent MR were performed at a longer interval after the initial operation. LVEDD expansion was better avoided in the CR group.
比较后二尖瓣脱垂（PMPL）患者行腱索重建（CR）和四边形切除术（QR）的早期和晚期术后结果。
回顾性分析 2008 年 1 月至 2018 年 12 月期间 305 例 PMPL 患者，其中 169 例行二尖瓣成形术（MVP）（CR 组），136 例行 QR（QR 组）。比较两组患者的早期和晚期术后结果。
96.4%（294/305）的患者完成了随访，平均随访 81.2±30.4 个月。所有患者均无 30 天内死亡。两组二尖瓣修复成功率相似（99.4% vs. 98.5%，P=0.850）。CR 组术后早期溶血发生率低于 QR 组（0.00% vs. 3.0%，P=0.024）。CR 组术后 3 个月时左心室舒张末期直径（LVEDD）较 QR 组显著下降（8.15[1.30，12.65] vs. 3.25[-0.05，8.75]mm，P<0.001）。随访期间，CR 组和 QR 组的总体生存率分别为 95.1%和 94.6%。两组中度或重度二尖瓣反流（MR）再手术发生率相似（4.3% vs. 5.4%，P=0.653），但 QR 组的手术间隔时间短于 CR 组（84.3±36.1 vs. 120.9±27.6 个月，P=0.026）。QR 组的 LVEDD 增大较 CR 组更为显著（4.5[3.6，4.5] vs. 2.4[1.3，2.8]mm，P<0.001）。
CR 和 QR 是治疗 PMPL 患者的有效技术。两种技术均导致复发性 MR 的发生率较低。然而，CR 可以更显著地减少术后早期溶血和 LVEDD。在长期随访中，由于复发性 MR 而进行的再次手术在初始手术后的间隔时间较长。CR 组更好地避免了 LVEDD 扩张。
