Yang Ye, Liu Fangyu, Wang Yulin, Xia Limin, Wang Chunsheng, Ji Qiang
Department of Cardiovascular Surgery, Zhongshan Hospital Fudan University, 200032 Shanghai, China.
Department of Cardiovascular Surgery, Xiamen Branch of Zhongshan Hospital Fudan University, 361015 Xiamen, Fujian, China.
Rev Cardiovasc Med. 2023 Nov 24;24(11):328. doi: 10.31083/j.rcm2411328. eCollection 2023 Nov.
Numerous studies have examined the therapeutic effects of mitral valve repair during revascularization on moderate ischemic mitral regurgitation (IMR), as well as the incremental benefit of subvalvular repair alongside an annuloplasty ring. However, the impact of depressed left ventricular (LV) function on the surgical outcome of patients with moderate IMR has been rarely investigated. The aims of this single-center, retrospective, observational study were firstly to evaluate short- and medium-term outcomes in this patient group after undergoing mitral valve repair during revascularization, and secondly to assess the impact of depressed LV function on surgical outcomes.
A total of 272 eligible patients who had moderate IMR and underwent concomitant mitral valve repair and revascularization from January 2010 to December 2017 were included in the study. These patients were categorized into different groups based on their ejection fraction (EF) levels: an EF 40% group (n = 90) and an EF 40% group (n = 182). The median time course of follow-up was 42 months and the shortest follow-up time was 30 months. This study compared in-hospital outcomes (major postoperative morbidity and surgical mortality) as well as midterm outcomes (moderate or more mitral regurgitation, all-cause mortality, and reoperation) of the two groups before and after propensity score (PS) matching (1:1).
No significant difference was observed in surgical mortality between groups (8.9% 3.3%, = 0.076). More patients in the EF 40% group developed low cardiac output (8.9% 2.7%, = 0.034) and prolonged ventilation (13.3% 5.5%, = 0.026) compared to the EF 40% group. Propensity score (PS) matching successfully established 82 patient pairs in a 1:1 ratio. No significance was discovered between the matched cohorts in terms of major postoperative morbidity and surgical mortality, except for prolonged ventilation. Conditional mixed-effects logistic regression analysis revealed that EF 40% had an independent impact on prolonged ventilation (odds ratio (OR) = 2.814, 95% CI 1.321-6.151, = 0.031), but was not an independent risk factor for surgical mortality (OR = 2.967, 95% CI 0.712-7.245, = 0.138) or other major postoperative morbidity. Furthermore, the two groups showed similar cumulative survival before (log-rank = 0.278) and after (stratified log-rank = 0.832) PS matching. regression analysis suggested that EF 40% was not related to mortality compared with EF 40% (PS-adjusted hazard ratio (HR) = 1.151, 95% CI 0.763-1.952, = 0.281).
Patients with moderate IMR and EF 40% shared similar midterm outcomes and surgical mortality to patients with moderate IMR and EF 40%, but received prolonged ventilation more often. Depressed LV function may be not associated with surgical or midterm mortality.
众多研究探讨了血运重建期间二尖瓣修复对中度缺血性二尖瓣反流（IMR）的治疗效果，以及瓣下修复联合瓣环成形环的额外获益。然而，左心室（LV）功能降低对中度IMR患者手术结局的影响鲜有研究。本单中心、回顾性、观察性研究的目的，一是评估该患者群体在血运重建期间接受二尖瓣修复后的短期和中期结局，二是评估LV功能降低对手术结局的影响。
本研究纳入了2010年1月至2017年12月期间共272例患有中度IMR且同时接受二尖瓣修复和血运重建的符合条件的患者。这些患者根据其射血分数（EF）水平分为不同组：EF≥40%组（n = 90）和EF＜40%组（n = 182）。随访的中位时间为42个月，最短随访时间为30个月。本研究比较了倾向评分（PS）匹配（1:1）前后两组的院内结局（术后主要并发症和手术死亡率）以及中期结局（中度或更严重的二尖瓣反流、全因死亡率和再次手术）。
两组之间的手术死亡率无显著差异（8.9%对3.3%，P = 0.076）。与EF≥40%组相比，EF＜40%组更多患者出现低心排血量（8.9%对2.7%，P = 0.034）和通气时间延长（13.3%对5.5%，P = 0.026）。倾向评分（PS）匹配成功以1:1的比例建立了82对患者。除通气时间延长外，匹配队列之间在术后主要并发症和手术死亡率方面未发现显著差异。条件混合效应逻辑回归分析显示，EF＜4
