Department of Cardiovascular Surgery National Cerebral and Cardiovascular Research Center Osaka Suita Japan.
Department of Cardiovascular Surgery Tohoku University Graduate School of Medicine Aoba-ku Sendai Japan.
J Am Heart Assoc. 2023 Jun 6;12(11):e028607. doi: 10.1161/JAHA.122.028607. Epub 2023 May 26.
Background This study assessed risk factors for mitral regurgitation (MR) recurrence or functional mitral stenosis during long-term follow-up in patients undergoing mitral valve repair for isolated posterior mitral leaflet prolapse. Methods and Results We assessed a consecutive series of 511 patients who underwent primary mitral valve repair for isolated posterior leaflet prolapse between 2001 and 2021. Annuloplasty using a partial band was selected in 86.3%. The leaflet resection technique was used in 83.0%, whereas the chordal replacement without resection was used in 14.5%. Risk factors were analyzed for MR recurrence ≥grade 2 or functional mitral stenosis with mean transmitral pressure gradient ≥5 mm Hg using a multivariable Fine-Gray regression model. The 1-, 5-, and 10-year cumulative incidence of MR ≥grade 2 was 7.8%, 22.7%, and 30.1%, respectively, whereas that of mean transmitral pressure gradient ≥5 mm Hg was 8.1%, 20.6%, and 29.3%, respectively. Risk factors for MR ≥grade 2 included chordal replacement without resection (hazard ratio [HR], 2.50, <0.001) and larger prosthesis size (HR, 1.13, =0.023), whereas factors for functional mitral stenosis were use of a full ring (partial band versus full ring, HR, 0.53, =0.013), smaller prosthesis size (HR, 0.74, <0.001), and larger body surface area (HR, 3.03, =0.045). Both MR ≥grade 2 and mean transmitral pressure gradient ≥5 mm Hg at 1 year post surgery were significantly associated with the long-term incidence of reoperation. Conclusions Leaflet resection with a large partial band may be an optimal strategy for isolated posterior mitral valve prolapse.
本研究评估了在因孤立性后瓣叶脱垂而接受二尖瓣修复术的患者中，长期随访时二尖瓣反流（MR）复发或功能性二尖瓣狭窄的危险因素。
我们评估了 2001 年至 2021 年间连续 511 例因孤立性后瓣叶脱垂而行初次二尖瓣修复术的患者。86.3%的患者采用部分环缩带瓣环成形术。83.0%的患者采用瓣叶切除术，14.5%的患者采用无瓣叶切除的腱索置换术。使用多变量 Fine-Gray 回归模型分析 MR 复发≥2 级或平均跨瓣压力梯度≥5mmHg的危险因素。MR≥2 级的 1、5 和 10 年累积发生率分别为 7.8%、22.7%和 30.1%，平均跨瓣压力梯度≥5mmHg 的分别为 8.1%、20.6%和 29.3%。MR≥2 级的危险因素包括无瓣叶切除的腱索置换术（危险比[HR]，2.50，<0.001）和更大的假体尺寸（HR，1.13，=0.023），而功能性二尖瓣狭窄的危险因素包括使用全环（部分环与全环，HR，0.53，=0.013）、更小的假体尺寸（HR，0.74，<0.001）和更大的体表面积（HR，3.03，=0.045）。术后 1 年时，MR≥2 级和平均跨瓣压力梯度≥5mmHg 与长期再手术的发生率显著相关。
对于孤立性后瓣叶脱垂，采用大的部分环缩带瓣叶切除术可能是一种最佳策略。
