Cardiac Surgery Unit, Lancisi Cardiovascular Center, Ospedali Riuniti delle Marche, Polytechnic University of Marche, Ancona, Italy.
Wessex Cardiothoracic Centre, University Hospital Southampton, University of Southampton, Southampton, UK.
J Cardiovasc Med (Hagerstown). 2024 Apr 1;25(4):334-341. doi: 10.2459/JCM.0000000000001599. Epub 2024 Feb 16.
The clinical benefits of mitral valve repair over replacement in the setting of mitral infective endocarditis are not clearly established.
Data of patients who underwent cardiac surgery for infective endocarditis over a 20-year period (2001-2021) at two cardiac centres were reviewed. Among them, 282 patients underwent native mitral valve surgery and were included in the study. Nearest-neighbour propensity-score matching was performed to account for differences in patients' profile between the repair and replacement subgroups.
Mitral valve replacement was performed in 186 patients, while in 96 cases patients underwent mitral valve repair. Propensity match analysis provided 89 well matched pairs. Mean age was 60 ± 15 years; 75% of the patients were male. Mitral valve replacement was more commonly performed in patients with involvement of both mitral leaflets, commissure(s) and mitral annulus. Patients with lesion(s) limited to P2 segment formed the majority of the cases undergoing mitral valve repair. There was no difference in terms of microbiological findings. In-hospital mortality was 7% with no difference between the repair and the replacement cohorts. Survival probabilities at 1, 5 and 10 years were 88%, 72% and 68%, respectively after mitral repair, and 88%, 78% and 63%, respectively after mitral replacement (log-rank P = 0.94).
Mitral valve repair was more commonly performed in patients with isolated single leaflet involvement and provided good early and 10-year outcomes. Patients with annular disruption, lesion(s) on both leaflets and commissure(s) were successfully served on early and mid-term course by mitral valve replacement.
在感染性心内膜炎的情况下，二尖瓣修复相对于置换的临床益处尚未明确。
回顾了两个心脏中心在 20 年期间（2001-2021 年）接受心脏手术治疗感染性心内膜炎的患者数据。其中，282 例患者接受了二尖瓣修复术，这些患者被纳入研究。采用最近邻居倾向评分匹配来解决修复和置换亚组患者特征的差异。
186 例患者行二尖瓣置换术，96 例患者行二尖瓣修复术。倾向评分匹配分析提供了 89 对匹配良好的病例。平均年龄为 60±15 岁，75%的患者为男性。二尖瓣置换术更多地用于二尖瓣两个瓣叶、交界和瓣环受累的患者。病变局限于 P2 段的患者多数行二尖瓣修复术。两组患者的微生物学发现无差异。院内死亡率为 7%，修复组和置换组之间无差异。二尖瓣修复后 1、5 和 10 年的生存率分别为 88%、72%和 68%，二尖瓣置换后分别为 88%、78%和 63%（对数秩 P=0.94）。
二尖瓣修复术更多地用于单个瓣叶受累的患者，可获得良好的早期和 10 年结果。瓣环破坏、两个瓣叶和交界受累的患者在早期和中期可通过二尖瓣置换术得到成功治疗。
