Department of Cardiac Surgery, IRCCS San Raffaele Hospital, Vita-Salute San Raffaele University, Milan, Italy.
University Centre of Statistics in Biomedical Sciences (CUSSB), Vita-Salute San Raffaele University, Milan, Italy.
Eur J Cardiothorac Surg. 2023 Oct 4;64(4). doi: 10.1093/ejcts/ezad274.
Uncorrected severe mitral regurgitation (MR) due to posterior prolapse leads to left ventricular dilatation. At this stage, mitral valve repair becomes mandatory to avoid permanent myocardial injury. However, which technique among neochoardae implantation and leaflet resection provides the best results in this scenario remains unknown.
We selected 332 patients with left ventricular dilatation and severe degenerative MR due to posterior leaflet (PL) prolapse who underwent neochoardae implantation (85 patients) or PL resection (247 patients) at our institution between 2008 and 2020. A propensity score matching analysis was carried on to decrease the differences at baseline.
Matching yielded 85 neochordae implantations and 85 PL resections. At 10 years, freedom from cardiac death and freedom from mitral valve reoperation were 92.6 ± 6.1% vs 97.8 ± 2.1% and 97.7 ± 2.2% vs 95 ± 3% in the neochordae group and in the PL resection group, respectively. The MR ≥2+ recurrence rate was 23.9 ± 10% in the neochordae group and 20.8 ± 5.8% in the PL resection group (P = 0.834) at 10 years. At the last follow-up, the neochordae group showed a higher reduction of left ventricular end-diastolic diameter (44 vs 48 mm; P = 0.001) and a better ejection fraction (60% vs 55%; P < 0.001) compared to PL resection group.
In this subgroup of patients, both neochordae implantation and leaflet resection provide excellent durability of the repair in the long term. Neochordae implantation might have a better effect on dilated left ventricle.
由于后瓣脱垂导致的未矫正的重度二尖瓣反流（MR）会引起左心室扩张。在这个阶段，为了避免永久性心肌损伤，二尖瓣修复是必需的。然而，在这种情况下，哪种技术（neochoardae 植入术和瓣叶切除术）提供最佳结果仍然未知。
我们选择了 2008 年至 2020 年间在我院接受 neochoardae 植入术（85 例）或 PL 切除术（247 例）的 332 例因后叶（PL）脱垂导致左心室扩张和严重退行性 MR 的患者。进行倾向评分匹配分析以减少基线差异。
匹配得到 85 例 neochoardae 植入术和 85 例 PL 切除术。在 10 年时，neochoardae 组和 PL 切除术组的无心脏死亡和无二尖瓣再手术生存率分别为 92.6±6.1% vs 97.8±2.1%和 97.7±2.2% vs 95±3%。neochoardae 组的 MR≥2+复发率为 23.9±10%，PL 切除术组为 20.8±5.8%（P=0.834）。在最后一次随访时，neochoardae 组的左心室舒张末期直径（44 与 48mm；P=0.001）和射血分数（60%与 55%；P<0.001）的降低幅度均大于 PL 切除术组。
在这个亚组患者中，neochoardae 植入术和瓣叶切除术在长期内均能提供出色的修复耐久性。neochoardae 植入术可能对扩张的左心室有更好的效果。
