二尖瓣修复术中测量人工腱索治疗前叶脱垂和连枷的轨迹技术与传统方法的比较。

Comparison between Track Technique and Conventional Approach for Measuring Artificial Chordae in the Treatment of Anterior Leaflet Prolapse and Flail during Mitral Valve Repair.

作者信息

Nasso Giuseppe, Santarpino Giuseppe, Bonifazi Raffaele, Fiore Flavio, Contegiacomo Gaetano, Agrò Felice Eugenio, Condello Ignazio, Dimita Giacomo, Bartolomucci Francesco, Fattouch Khalil, Moscarelli Marco, Di Bari Nicola, Speziale Giuseppe

机构信息

Department of Cardiac Surgery, Anthea Hospital, GVM Care & Research, 70124 Bari, Italy.

Department of Cardiac Surgery, Città di Lecce Hospital, GVM Care & Research, 73100 Lecce, Italy.

出版信息

Rev Cardiovasc Med. 2023 Oct 20;24(10):301. doi: 10.31083/j.rcm2410301. eCollection 2023 Oct.

DOI:10.31083/j.rcm2410301

PMID:39077566

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC11273126/

Abstract

BACKGROUND

Measuring the chordae tendineae for mitral valve reconstruction is feasible with various techniques. However, the effect of different strategies on the durability of plastics at follow-up is unknown. The study aims to compare a conventional surgical technique for measuring artificial chordae length with our new approach, defined "track technique".

METHODS

We compared the results of patients with anterior leaflet prolapse/flail who underwent mitral valve reconstruction by implanting artificial chordae from January 2020 to January 2022; 22 patients were operated on with a conventional technique, and 25 with our new alternative, "track technique". Clinical and transesophageal echocardiography data were collected postoperatively and at 2 years of follow-up. The primary outcome was freedom from mitral regurgitation. Secondary outcomes were presentation with New York Heart Association (NYHA) class 2 and leaflet coaptation length 10 mm.

RESULTS

The patients of the 2 groups had comparable preoperative risk factors regarding the LogEuroSCORE ( = 0.33). Moreover, no difference was observed in terms of the mechanism of mitral valve insufficiency. No hospital or follow-up deaths were recorded for either group. At discharge, no echocardiographic differences were observed in the regarding degree of residual mitral regurgitation, but the measurement of coaptation length was in favor of the alternative group (8.6 1.8 vs. 11 1.4; = 0.04). At 2 years of follow-up (25 9; range 13-37), the NYHA class was not different; however, the number of patients with 1-2+ recurrent mitral regurgitation was significantly higher in the conventional group (8 vs. 4 patients; = 0.02), and the coaptation length was in favor of the alternative group (8.8 1.7 vs. 11 1.7; = 0.04).

CONCLUSIONS

We devised both techniques to prove effective in achieving good valvular continence, but a significantly greater coaptation length was obtained with our track technique at the 2 years follow-up.

摘要

背景

采用多种技术测量用于二尖瓣重建的腱索是可行的。然而，不同策略对随访时人工瓣的耐久性影响尚不清楚。本研究旨在比较一种测量人工腱索长度的传统手术技术与我们新的方法，即“轨迹技术”。

方法

我们比较了2020年1月至2022年1月期间因植入人工腱索而接受二尖瓣重建的前叶脱垂/连枷样病变患者的结果；22例患者采用传统技术进行手术，25例采用我们新的“轨迹技术”。术后及随访2年时收集临床和经食管超声心动图数据。主要结局是无二尖瓣反流。次要结局是纽约心脏协会（NYHA）心功能分级达到2级且瓣叶对合长度≥10mm。

结果

两组患者在LogEuroSCORE方面术前危险因素相当（P = 0.33）。此外，二尖瓣关闭不全机制方面未观察到差异。两组均未记录到住院或随访死亡病例。出院时，在残余二尖瓣反流程度方面未观察到超声心动图差异，但瓣叶对合长度测量结果有利于新方法组（8.6±1.8 vs. 11±1.4；P = 0.04）。随访2年时（25±9；范围13 - 37），NYHA心功能分级无差异；然而，传统组1 - 2+级复发性二尖瓣反流患者数量显著更高（8例 vs. 4例患者；P = 0.02），且瓣叶对合长度有利于新方法组（8.8±1.7 vs. 11±1.7；P = 0.04）。