Adult Cardiac Surgery Department, Prince Sultan Cardiac Center, Riyadh, Saudi Arabia.
Cardiothoracic Surgery Department, Tanta University, Tanta, Egypt.
Angiology. 2024 Apr;75(4):331-339. doi: 10.1177/00033197231154353. Epub 2023 Jan 29.
There is no consensus regarding mitral valve management during surgical ventricular restoration (SVR) for ischemic cardiomyopathy. We compared the impact of SVR with mitral valve repair (MVr) vs replacement (MVR) on postoperative outcomes and long-term survival in ischemic cardiomyopathy and mitral regurgitation patients. This study included 112 patients who underwent SVR from 2009 to 2018 with MVr (n = 75) or MVR (n = 37). Patients who had MVR had higher Euro SCORE II, dyspnea class, a lower ejection fraction, higher pulmonary artery systolic pressure, higher grade of preoperative mitral and tricuspid regurgitation, and higher end-diastolic and end-systolic diameters. Intra-aortic balloon pump was more commonly used in patients with MVR. Hospital mortality occurred in 7 (9.33%) patients in the MVr group vs 3 (8.11%) in the MVR group (P > .99). Freedom from rehospitalization at 1, 5, and 7 years was 87%, 76%, and 70% in the MVr group and 83%, 61%, and 52% in the MVR group (P = .191). Survival at 1, 5, and 7 years was 88%, 78%, and 74% in the MVr group and 88%, 56%, and 56% in the MVR group (P = .027). Adjusted survival did not differ between groups.MVr or MVR are valid options in patients undergoing SVR, with good long-term outcomes.
对于缺血性心肌病的外科心室修复（SVR），在二尖瓣管理方面尚无共识。我们比较了 SVR 联合二尖瓣修复（MVr）与二尖瓣置换（MVR）对缺血性心肌病和二尖瓣反流患者术后结果和长期生存的影响。这项研究纳入了 2009 年至 2018 年期间接受 SVR 的 112 例患者，其中行 MVR（n=75）或 MVR（n=37）。行 MVR 的患者具有更高的欧洲心脏手术风险评分 II、呼吸困难分级、更低的射血分数、更高的肺动脉收缩压、更高的术前二尖瓣和三尖瓣反流分级、更大的舒张末期和收缩末期直径。主动脉内球囊反搏在 MVR 患者中更为常用。MVr 组有 7 例（9.33%）患者发生院内死亡，MVR 组有 3 例（8.11%）患者发生院内死亡（P＞.99）。MVr 组的 1、5、7 年无再住院率分别为 87%、76%和 70%，MVR 组分别为 83%、61%和 52%（P=.191）。MVr 组的 1、5、7 年生存率分别为 88%、78%和 74%，MVR 组分别为 88%、56%和 56%（P=.027）。调整后的生存率在两组之间没有差异。在接受 SVR 的患者中，MVr 或 MVR 都是有效的选择，具有良好的长期预后。
