Division of Cardiothoracic Surgery, Department of Surgery, Duke University Medical Center, Durham, North Carolina; Department of Thoracic and Cardiovascular Surgery, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Republic of Korea.
Division of Cardiothoracic Surgery, Department of Surgery, Duke University Medical Center, Durham, North Carolina.
Ann Thorac Surg. 2024 Nov;118(5):1161-1166. doi: 10.1016/j.athoracsur.2024.06.036. Epub 2024 Aug 3.
Debate persists regarding the outcomes of leaflet resection (RESECT) vs chordal replacement (CHORD) for degenerative mitral regurgitation. Our aim was to compare early and late outcomes of the RESECT vs CHORD techniques for degenerative mitral regurgitation.
A total of 1066 consecutive patients undergoing mitral repair for degenerative regurgitation with the RESECT vs CHORD techniques were evaluated from a prospectively maintained database. Propensity score matching was used to compare outcomes in RESECT vs CHORD repairs.
Patients who underwent CHORD had later operative dates, more flail leaflet, and more anterior leaflet disease. With the switch to predominant use of the CHORD technique in 2010, the percentage of repair for all degenerative valves improved significantly from 83% to 91% (P = .002). A total of 467 patients were matched for baseline characteristics. Patients in the CHORD group had larger rings (34 mm vs 32 mm; P < .001) and greater use of an Alfieri stitch (66% vs 22%; P < .001) in matched patients. The 10-year survival was similar for matched patients (RESECT vs CHORD, 86% ± 3% vs 84% ± 4%; P = .5).Patients in the RESECT group had a lower 10-year cumulative incidence of mitral reoperation (RESECT vs CHORD, 1% ± 1% vs 8% ± 3%; P = .002) and severe mitral regurgitation (RESECT vs CHORD, 1% ± 1% vs 9% ± 5%; P = .05) compared with matched patients in the CHORD group. The late ejection fraction and mitral gradient were not different between the 2 groups in matched patients, respectively (P = .9 and P = .2, respectively).
The use of the CHORD technique for degenerative mitral regurgitation increased the repair rates, but the CHORD technique had slightly lower repair durability at 10 years compared with the RESECT technique. These results could be related to more complex disease in CHORD group.
对于退行性二尖瓣关闭不全，瓣叶切除（RESECT）与瓣环成形（CHORD）的结局仍存在争议。本研究旨在比较退行性二尖瓣关闭不全患者接受 RESECT 与 CHORD 技术的早期和晚期结果。
从一个前瞻性维护的数据库中评估了 1066 例连续接受退行性反流二尖瓣修复的患者，其中采用 RESECT 与 CHORD 技术。采用倾向评分匹配比较 RESECT 与 CHORD 修复的结果。
接受 CHORD 手术的患者手术时间较晚，瓣叶撕裂更多，前瓣叶病变更多。随着 2010 年 CHORD 技术的广泛应用，所有退行性瓣膜修复的比例从 83%显著提高到 91%（P=0.002）。共有 467 例患者匹配了基线特征。CHORD 组患者的环更大（34mm vs 32mm；P<0.001），Alfieri 缝合的使用率更高（66% vs 22%；P<0.001）。在匹配患者中，10 年生存率相似（RESECT 组 vs CHORD 组，86%±3% vs 84%±4%；P=0.5）。RESECT 组患者的二尖瓣再手术 10 年累积发生率较低（RESECT 组 vs CHORD 组，1%±1% vs 8%±3%；P=0.002）和重度二尖瓣反流（RESECT 组 vs CHORD 组，1%±1% vs 9%±5%；P=0.05）。在匹配患者中，两组的晚期射血分数和二尖瓣梯度无差异（分别为 P=0.9 和 P=0.2）。
退行性二尖瓣关闭不全采用 CHORD 技术增加了修复率，但与 RESECT 技术相比，10 年时 CHORD 技术的修复耐久性略低。这些结果可能与 CHORD 组患者更复杂的疾病有关。
