Department of Cardiovascular Surgery, Hospital Clínic, Barcelona, Spain.
Department of Cardiology, Hospital Clínic, Barcelona, Spain.
Eur J Cardiothorac Surg. 2023 Aug 1;64(2). doi: 10.1093/ejcts/ezad235.
Surgical repair remains the best treatment for severe primary mitral regurgitation (MR). Minimally invasive mitral valve surgery is being increasingly performed, but there is a lack of solid evidence comparing thoracoscopic with conventional surgery. Our objective was to compare outcomes of both approaches for repair of leaflet prolapse.
All consecutive patients undergoing surgery for severe MR due to mitral prolapse from 2012 to 2020 were evaluated according to the approach used. Freedom from mortality, reoperation and recurrent severe MR were evaluated by Kaplan-Meier method. Differences in baseline characteristics were adjusted with propensity score-matched analysis (1:1, nearest neighbour).
Three hundred patients met inclusion criteria and were divided into thoracoscopic (N = 188) and conventional (sternotomy; N = 112) groups. Unmatched patients in the thoracoscopic group were younger and had lower body mass index, New York Heart Association class and EuroSCORE II preoperatively. After matching, thoracoscopic group presented significantly shorter mechanical ventilation (9 vs 15 h), shorter intensive care unit stay (41 vs 65 h) and higher postoperative haemoglobin levels (11 vs 10.2 mg/dl) despite longer bypass and cross-clamp times (+30 and +17 min). There were no differences in mortality or MR grade at discharge between groups nor differences in survival, repair failures and reinterventions during follow-up.
Minimally invasive mitral repair can be performed in the majority of patients with mitral prolapse, without compromising outcomes, repair rate or durability, while providing shorter mechanical ventilation and intensive care unit stay and less blood loss.
外科修复仍然是严重原发性二尖瓣反流（MR）的最佳治疗方法。微创二尖瓣手术的应用越来越广泛，但缺乏比较胸腔镜与传统手术的可靠证据。我们的目的是比较两种方法治疗瓣叶脱垂的结果。
根据所采用的方法，评估 2012 年至 2020 年间因二尖瓣脱垂而行手术治疗的所有连续重度 MR 患者。通过 Kaplan-Meier 方法评估无死亡率、再次手术和复发性重度 MR 的情况。通过倾向性评分匹配分析（1:1，最近邻）调整基线特征差异。
300 名患者符合纳入标准，分为胸腔镜（n=188）和传统（胸骨切开术；n=112）组。胸腔镜组的未匹配患者在手术前更年轻，体重指数、纽约心脏协会（NYHA）分级和欧洲心脏手术风险评分 II（EuroSCORE II）较低。匹配后，胸腔镜组的机械通气时间（9 小时比 15 小时）、重症监护病房（ICU）住院时间（41 小时比 65 小时）和术后血红蛋白水平（11 毫克/分升比 10.2 毫克/分升）均显著缩短，但体外循环和主动脉阻断时间分别延长了 30 分钟和 17 分钟。两组在出院时的死亡率或 MR 分级、生存情况、修复失败和随访期间的再次干预方面均无差异。
对于大多数二尖瓣脱垂患者，微创二尖瓣修复可以安全施行，不会影响结果、修复率或耐久性，同时可缩短机械通气和 ICU 住院时间，并减少出血量。
