Lai Wei-Tsung, Chen I-Chen, Hsiung Ming-Chon, Lin Ting-Chao, Huang Kuan-Chih, Chang Chung-Yi, Wei Jeng
Division of Cardiovascular Medicine, Department of Internal Medicine, China Medical University Hsinchu Hospital, Hsinchu, Taiwan.
Heart Center, Cheng-Hsin General Hospital, Taipei, Taiwan.
Int J Cardiol Cardiovasc Risk Prev. 2024 Sep 2;23:200329. doi: 10.1016/j.ijcrp.2024.200329. eCollection 2024 Dec.
Severe aortic regurgitation (AR) and mitral regurgitation (MR) can lead to left ventricular (LV) systolic dysfunction; however, there are limited data about recovery of LV after surgery for AR or MR. Little is known to guide the management of combined AR and MR (mixed valvular heart disease [VHD]). This study is sought to investigate the predictors of postoperative LV function recovery in left-sided regurgitant VHD with reduced left ventricular ejection fraction (LVEF), especially for mixed VHD.
From 2010 to 2020, 2053 adult patients underwent aortic or mitral valve surgery at our center. The patients with valvular stenosis, infective endocarditis, concomitant revascularization, and preoperative LVEF ≥40 % were excluded. A total of 127 patients were included in this study: 22 patients with predominant AR (AR group), 64 with predominant MR (MR group), and 41 with combined AR and MR (AMR group).
The mean preoperative LVEF was 32.4 %, 30.7 %, and 30.2 % (p = 0.44) in the AR, MR, and AMR groups, respectively. The AR group was more likely to have postoperative LVEF recovery. The cut-point of left ventricular end-systolic diameter (LVESD) for better recovery was 49 mm for the MR group and 58 mm for the AMR group.
LV dysfunction due to combined AR and MR has similar remodeling reserve as AR, and better recoverability than MR. Thus, double-valve surgery is recommended before the LVESD is > 58 mm.
重度主动脉瓣反流（AR）和二尖瓣反流（MR）可导致左心室（LV）收缩功能障碍；然而，关于AR或MR手术后左心室恢复的数据有限。对于合并AR和MR（混合性心脏瓣膜病[VHD]）的管理，目前所知甚少。本研究旨在调查左心室射血分数（LVEF）降低的左侧反流性VHD患者术后左心室功能恢复的预测因素，尤其是混合性VHD患者。
2010年至2020年，2053例成年患者在我们中心接受了主动脉瓣或二尖瓣手术。排除瓣膜狭窄、感染性心内膜炎、同期血运重建以及术前LVEF≥40%的患者。本研究共纳入127例患者：22例以AR为主（AR组），64例以MR为主（MR组），41例合并AR和MR（AMR组）。
AR组、MR组和AMR组术前平均LVEF分别为32.4%、30.7%和30.2%（p = 0.44）。AR组术后LVEF恢复的可能性更大。MR组左心室收缩末期内径（LVESD）更好恢复的切点为49mm，AMR组为58mm。
合并AR和MR导致的左心室功能障碍与AR具有相似的重塑储备，且恢复能力优于MR。因此，建议在LVESD>58mm之前进行双瓣手术。
