Hu Yu-Ning, Lee Wen-Huang, Tsai Meng-Ta, Wang Yi-Chen, Shih Chao-Jung, Huang Yu-Ching, Roan Jun-Neng
Division of Cardiovascular Surgery, Department of Surgery, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan 704, Taiwan.
Division of Cardiology, Department of Internal Medicine, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan 704, Taiwan.
J Cardiovasc Dev Dis. 2023 Nov 19;10(11):470. doi: 10.3390/jcdd10110470.
To optimize mitral valve repair outcomes, it is crucial to comprehend the predictors of functional mitral valve stenosis (FMS), to enhance preoperative assessments, and to adapt intraoperative treatment strategies. This study aimed to identify FMS risk factors, contributing valuable insights for refining surgical techniques. Among 228 selected patients, 215 underwent postoperative echocardiography follow-ups, and 36 met the FMS criteria based on a mean trans-mitral pressure gradient of >5 mmHg. Patients with FMS exhibited higher pulmonary systolic arterial pressure and increased late mortality during the follow-up. Univariable logistic regression analysis identified several risk factors for FMS, including end-stage renal disease, anterior leaflet lesion, concomitant aortic valve replacement, smaller ring size, ring type, and neochordae implantation. Conversely, resection alone and resection combined with neochordae implantation had protective effects against FMS. Multivariable logistic regression analysis revealed that smaller ring sizes and patch repair independently predicted FMS. When focusing on degenerative mitral regurgitation, the neochordae implantation without resection in leaflet repair, emerged as an independent predictor of FMS. Surgeons should weigh the substantial impact of surgical procedures on postoperative trans-mitral pressure gradients, emphasizing preoperative evaluation and techniques such as precise ring size assessment and effective leaflet management.
为优化二尖瓣修复效果，理解功能性二尖瓣狭窄（FMS）的预测因素、加强术前评估并调整术中治疗策略至关重要。本研究旨在识别FMS的危险因素，为改进手术技术提供有价值的见解。在228例选定患者中，215例接受了术后超声心动图随访，36例根据平均跨二尖瓣压力梯度>5 mmHg符合FMS标准。FMS患者在随访期间表现出更高的肺动脉收缩压和更高的晚期死亡率。单因素逻辑回归分析确定了FMS的几个危险因素，包括终末期肾病、前叶病变、同期主动脉瓣置换、较小的瓣环尺寸、瓣环类型和新腱索植入。相反，单纯切除以及切除联合新腱索植入对FMS有保护作用。多因素逻辑回归分析显示，较小的瓣环尺寸和补片修复独立预测FMS。当关注退行性二尖瓣反流时，在瓣叶修复中不切除而植入新腱索成为FMS的独立预测因素。外科医生应权衡手术操作对术后跨二尖瓣压力梯度的重大影响，强调术前评估以及精确瓣环尺寸评估和有效瓣叶处理等技术。
