缺血性二尖瓣反流：修复还是置换？单中心经验。
Ischemic mitral regurgitation: To repair or replace? A single center experience.
机构信息
Department of Cardiothoracic Surgery, University of Louisville, Louisville, Kentucky, United States of America.
School of Medicine, University of Louisville, Louisville, Kentucky, United States of America.
出版信息
PLoS One. 2024 Oct 24;19(10):e0307449. doi: 10.1371/journal.pone.0307449. eCollection 2024.
OBJECTIVE
Recent reports on ischemic mitral valve (MV) regurgitation surgical strategies have suggested better hemodynamic performance with MV replacement (MVR) than MV repair (MVr) with no survival difference at 2 years. We evaluated the difference between MVR and MVr outcomes in patients with ischemic MR, including hemodynamic MV performance at 1 and 2 years postoperatively.
METHODS
A single center cardiac surgery database was queried for patients (aged >/ = 18 years) requiring mitral valve surgery with concomitant CABG or PCI between January 2010 and June 2018. Patients were separated into two groups: mitral valve repair using ring annuloplasty (MVr) and mitral valve replacement (MVR).
RESULTS
A total of 111 patients (median age 66 years, 76% male) underwent an operation for ischemic mitral regurgitation during the study period. (44%) had MVr and 62 (56%) had MVR. Both groups had > 80% concomitant CABG. The MVr group had lower EF (40% vs. 55%, p < 0.01), shorter cardiopulmonary bypass time (117 vs. 164 minutes, p < .01) and shorter aortic cross-clamp time (80 vs. 116 minutes, p < .01). The in-hospital mortality (6% vs. 10%, p = 1.00) and 1-year mortality (14% vs. 18%, p = 0.17) were similar between the groups. Pre-operative left ventricular internal diameter at end-diastole was greater in the MVr group (5.6cm vs. 4.6cm, p < .01). At 1-year, more patients in the MVR group had no or trace regurgitation (29% vs. 61%, p = 0.01), however, the number of patients with moderate or greater mitral regurgitation was similar (6% vs. 12%, p = 0.69). At 2-years, the MVr and MVR groups had no difference in moderate or severe mitral regurgitation (7% vs. 13%, p = 0.68).
CONCLUSION
Our findings demonstrate similar early mortality and mid-term mitral valve performance, suggesting that MV repair could be a good surgical option in patients with ischemic MR requiring surgical revascularization.
目的
最近关于缺血性二尖瓣反流（MR）手术策略的报告表明，二尖瓣置换术（MVR）在血流动力学方面优于二尖瓣修复术（MVr），且术后 2 年生存率无差异。我们评估了缺血性 MR 患者中 MVR 和 MVr 治疗结果的差异，包括术后 1 年和 2 年的二尖瓣血流动力学表现。
方法
对 2010 年 1 月至 2018 年 6 月期间因缺血性 MR 接受二尖瓣手术且同期行冠状动脉旁路移植术（CABG）或经皮冠状动脉介入治疗（PCI）的患者，从单一中心心脏手术数据库中进行检索。患者分为两组：采用环形瓣环成形术的二尖瓣修复术（MVr）和二尖瓣置换术（MVR）。
结果
研究期间共有 111 例（中位年龄 66 岁，76%为男性）患者因缺血性二尖瓣关闭不全接受手术治疗。其中 44%的患者接受 MVr，62 例（56%）接受 MVR。两组均有超过 80%的患者同期行 CABG。MVr 组的射血分数（EF）较低（40% vs. 55%，p < 0.01），体外循环时间（117 分钟 vs. 164 分钟，p < 0.01）和主动脉阻断时间（80 分钟 vs. 116 分钟，p < 0.01）较短。院内死亡率（6% vs. 10%，p = 1.00）和 1 年死亡率（14% vs. 18%，p = 0.17）在两组之间相似。MVr 组术前左心室舒张末期内径较大（5.6cm vs. 4.6cm，p < 0.01）。1 年时，MVR 组更多患者无或微量反流（29% vs. 61%，p = 0.01），但中重度二尖瓣反流患者数量相似（6% vs. 12%，p = 0.69）。2 年时，MVr 和 MVR 组中重度二尖瓣反流无差异（7% vs. 13%，p = 0.68）。
结论
我们的发现表明早期死亡率和中期二尖瓣功能相似，提示对于需要手术血运重建的缺血性 MR 患者，二尖瓣修复术可能是一种良好的手术选择。
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