Wisniewski Alex M, Sutherland Grant N, Strobel Raymond J, Young Andrew, Norman Anthony V, Quader Mohammed, Yount Kenan W, Teman Nicholas R
Division of Cardiac Surgery, University of Virginia, Charlottesville, Va.
Division of Thoracic and Cardiovascular Surgery, Virginia Commonwealth University, Richmond, Va.
JTCVS Tech. 2024 Jan 18;24:66-75. doi: 10.1016/j.xjtc.2024.01.004. eCollection 2024 Apr.
Mitral valve repair is the gold standard for treatment of mitral regurgitation, but the optimal technique remains debated. By using a regional collaborative, we sought to determine the change in repair technique over time.
We identified all patients undergoing isolated mitral valve repair from 2012 to 2022 for degenerative mitral disease. Those with endocarditis, transcatheter repair, or tricuspid intervention were excluded. Continuous variables were analyzed via Wilcoxon rank sum, and categorical variables were analyzed via chi-square testing.
We identified 1653 patients who underwent mitral valve repair, with 875 (59.2%) undergoing a no resection repair. Over the last decade, there was no significant trend in the proportion of repair techniques across the region ( = .96). Those undergoing no resection repairs were more likely to have undergone prior cardiac surgery (5.0% vs 2.2%, = .002) or minimally invasive approaches (61.4% vs 24.7%, < .001) with similar predicted risk of mortality (median 0.6% vs 0.6%, = .75). Intraoperatively, no resection repairs were associated with longer bypass times (140 [117-167] minutes vs 122 [91-159] minutes, < .001). Operative mortality was similar between both groups (1.1% vs 1.0%, = .82), as were other postoperative outcomes. Anterior leaflet prolapse (odds ratio, 11.16 [6.34-19.65], < .001) and minimally invasive approach (odds ratio, 6.40 [5.06-8.10], < .001) were most predictive of no resection repair.
Despite minor differences in operative times, statewide over the past decade there remains a diverse mix of both classic "resect" and newer "respect" strategies with comparable short-term outcomes and no major timewise trends. These data may suggest that both approaches are equivocal.
二尖瓣修复术是治疗二尖瓣反流的金标准，但最佳技术仍存在争议。通过区域协作，我们试图确定修复技术随时间的变化。
我们确定了2012年至2022年期间所有因退行性二尖瓣疾病接受单纯二尖瓣修复术的患者。排除患有心内膜炎、经导管修复术或三尖瓣干预的患者。连续变量通过Wilcoxon秩和检验进行分析，分类变量通过卡方检验进行分析。
我们确定了1653例接受二尖瓣修复术的患者，其中875例（59.2%）接受了无切除修复术。在过去十年中，该地区修复技术的比例没有显著趋势（P = 0.96）。接受无切除修复术的患者更有可能接受过心脏手术（5.0%对2.2%，P = 0.002）或采用微创方法（61.4%对24.7%，P < 0.001），且预测死亡率相似（中位数0.6%对0.6%，P = 0.75）。术中，无切除修复术与更长的体外循环时间相关（140[117 - 167]分钟对122[91 - 159]分钟，P < 0.001）。两组的手术死亡率相似（1.1%对1.0%，P = 0.82），其他术后结果也相似。前叶脱垂（比值比，11.16[6.34 - 19.65]，P < 0.001）和微创方法（比值比，6.40[5.06 - 8.10]，P < 0.001）最能预测无切除修复术。
尽管手术时间存在细微差异，但在过去十年中，全州范围内经典的“切除”和较新的“保留”策略仍然多种多样，短期结果相当，且没有明显的时间趋势。这些数据可能表明两种方法都存在不确定性。
