Sugimori Haruhiko, Nakao Tatsuya, Okada Yukikatsu, Okita Yutaka, Yaku Hitoshi, Kobayashi Junjiro, Uesugi Hideyuki, Takanashi Shuichiro, Ito Toshiaki, Koyama Tadaaki, Sakaguchi Taichi, Yamamoto Kouji, Yoshikawa Yasushi, Sawa Yoshiki
Department of Cardiovascular Surgery, New Tokyo Hospital, 1271 Wanagaya, Matsudo, Chiba, 270-2232, Japan.
Department of Cardiovascular Surgery, Midori Hospital, 1-16 Edayoshi, Nishi-ku, Kobe, Hyogo, 651-2133, Japan.
Heart Vessels. 2024 Mar;39(3):252-265. doi: 10.1007/s00380-023-02325-x. Epub 2023 Oct 16.
This study retrospectively evaluated the mid-term outcomes of surgical aortic valve replacement (SAVR) using a stented porcine aortic valve bioprosthesis (Mosaic; Medtronic Inc., Minneapolis, MN, USA) with concomitant mitral valve (MV) repair. From 1999 to 2014, 157 patients (median [interquartile range] age, 75 [70-79] years; 47% women) underwent SAVR with concomitant MV repair (SAVR + MV repair), and 1045 patients (median [interquartile range] age, 76 [70-80] years; 54% women) underwent SAVR only at 10 centers in Japan as part of the long-term multicenter Japan Mosaic valve (J-MOVE) study. The 5-year overall survival rate was 81.5% ± 4.1% in the SAVR + MV repair group and 85.1% ± 1.4% in the SAVR only group, and the 8-year overall survival rates were 75.2% ± 5.7% and 78.1% ± 2.1%, respectively. Cox proportional hazards analysis showed no significant difference in the survival rates between the two groups (hazard ratio, 0.87; 95% confidence interval, 0.54-1.40; P = 0.576). Among women with mild or moderate mitral regurgitation who were not receiving dialysis, those who underwent SAVR + MV repair, were aged > 75 years, and had a preoperative left ventricular ejection fraction of 30-75% tended to have a lower mortality risk. In conclusion, this subgroup analysis of the J-MOVE cohort showed relevant mid-term outcomes after SAVR + MV repair.
本研究回顾性评估了使用带支架猪主动脉瓣生物假体（Mosaic；美敦力公司，美国明尼苏达州明尼阿波利斯）并同期进行二尖瓣（MV）修复的外科主动脉瓣置换术（SAVR）的中期结果。1999年至2014年，157例患者（年龄中位数[四分位间距]为75[70 - 79]岁；47%为女性）接受了SAVR并同期进行MV修复（SAVR + MV修复），1045例患者（年龄中位数[四分位间距]为76[70 - 80]岁；54%为女性）在日本的10个中心仅接受了SAVR，这是长期多中心日本Mosaic瓣膜（J - MOVE）研究的一部分。SAVR + MV修复组的5年总生存率为81.5%±4.1%，仅SAVR组为85.1%±1.4%，8年总生存率分别为75.2%±5.7%和78.1%±2.1%。Cox比例风险分析显示两组生存率无显著差异（风险比，0.87；95%置信区间，0.54 - 1.40；P = 0.576）。在未接受透析的轻度或中度二尖瓣反流女性中，接受SAVR + MV修复、年龄>75岁且术前左心室射血分数为30 - 75%的患者死亡风险往往较低。总之，J - MOVE队列的这一亚组分析显示了SAVR + MV修复后的相关中期结果。
