退行性疾病二尖瓣修复失败后的再次手术：单中心外科医生经验
Reoperation after failure of mitral valve repair for degenerative disease: A single surgeon experience.
作者信息
Divya Aabha, Akintoye Oluwanifemi O, Wells Francis
机构信息
Cardiothoracic Surgery, Royal Papworth Hospital NHS Trust, Cambridge, United Kingdom.
出版信息
JTCVS Open. 2023 Oct 11;16:221-233. doi: 10.1016/j.xjon.2023.10.003. eCollection 2023 Dec.
BACKGROUND
With an increasing number of patients undergoing mitral valve repair, more patients are presenting for reoperation. This study aimed to evaluate factors influencing mortality and survival of patients undergoing reoperation for mitral valve surgery after previous mitral valve repair under a single surgeon.
METHODS
We retrospectively collected data from 117 patients who underwent reoperation after previous mitral valve repair between 2010 and 2022. We aimed to identify preoperative, operative, and postoperative factors affecting outcomes. The primary outcome was overall survival, and the secondary outcomes included prolonged hospital stay and in-hospital mortality. The mean follow-up was 9.13 ± 10.36 years (median, 6.50 years).
RESULTS
Out of 117 patients, 85 underwent mitral valve replacement (MVR) and 32 underwent mitral valve repair (MVr). The mean age was 64.7 ± 12.7 years (65.5 ± 12.2 years in the MVR group and 62.7 ± 14.0 years in the MVr group), and 66 (56.4%) were men. On a standard multivariate analysis of the overall factors influencing mortality, advanced age was associated with a higher risk of overall mortality (hazard ratio [HR], 1.07; 95% confidence interval [CI], f1.03-1.12; = .001). The urgency of surgical intervention also played a role, with a higher risk of in-hospital mortality in patients undergoing emergency reoperation (HR, 1.55; 95% CI, 1.60-149.05; = .02). Furthermore, the presence of mixed lesions, encompassing both mitral regurgitation and stenosis, was strongly linked to increased overall mortality (HR, 17.09; 95% CI, 4.06-71.94; < .001) and in-hospital mortality (HR, 1.75; 95% CI, 15.83-1925.61; < .001). Infective endocarditis emerged as a prominent risk factor for overall mortality (HR, 992.08; 95% CI, 85.74-11,479.08; < .001) and in-hospital mortality (HR, 5.83; 95% CI, 514.81-65,932.99; < .001). Additionally, chronic obstructive pulmonary disease was associated with a significantly increased risk of overall mortality (HR, 4.3; 95% CI, 1.24-14.97; = .02).
CONCLUSIONS
Our single surgeon experience demonstrates that mitral valve reoperation after a previous repair is associated with good outcomes and survival.
背景
随着接受二尖瓣修复手术的患者数量不断增加，需要再次手术的患者也越来越多。本研究旨在评估影响曾接受二尖瓣修复手术的患者再次接受二尖瓣手术的死亡率和生存率的因素。
方法
我们回顾性收集了2010年至2022年间117例曾接受二尖瓣修复手术并再次接受手术的患者的数据。我们旨在确定影响手术结果的术前、术中及术后因素。主要结局是总体生存率，次要结局包括住院时间延长和院内死亡率。平均随访时间为9.13±10.36年（中位数为6.50年）。
结果
117例患者中，85例行二尖瓣置换术（MVR），32例行二尖瓣修复术（MVr）。平均年龄为64.7±12.7岁（MVR组为65.5±12.2岁，MVr组为62.7±14.0岁），66例（56.4%）为男性。在对影响死亡率的总体因素进行的标准多变量分析中，高龄与总体死亡风险较高相关（风险比[HR]，1.07；95%置信区间[CI]，1.03 - 1.12；P = 0.001）。手术干预的紧迫性也起了作用，接受急诊再次手术的患者院内死亡风险较高（HR，1.55；95% CI，1.60 - 149.05；P = 0.02）。此外，存在二尖瓣反流和狭窄的混合病变与总体死亡率增加（HR，17.09；95% CI，4.06 - 71.94；P < 0.001）和院内死亡率增加（HR，1.75；95% CI，15.83 - 1925.61；P < 0.001）密切相关。感染性心内膜炎成为总体死亡率（HR，992.08；95% CI，85.74 - 11479.08；P < 0.001）和院内死亡率（HR，5.83；95% CI，514.81 - 65932.99；P < 0.001）的一个突出危险因素。此外，慢性阻塞性肺疾病与总体死亡风险显著增加相关（HR，4.3；95% CI，1.24 - 14.97；P = 0.02）。
结论
我们单中心的经验表明，既往修复术后的二尖瓣再次手术与良好的手术结果和生存率相关。
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