Zancanaro Edoardo, Carino Davide, Lorusso Roberto, Del Forno Benedetto, Lapenna Elisabetta, Sala Alessandra, Ascione Guido, Scarale Maria Giovanna, Nonis Alessandro, Castiglioni Alessandro, Alfieri Ottavio, Maisano Francesco, De Bonis Michele
Department of Cardiac Surgery, IRCCS San Raffaele Scientific Institute, Vita-Salute San Raffaele University, Milan, Italy.
Cardio-Thoracic Surgery Department, Heart and Vascular Centre, Maastricht University Medical Centre, Maastricht, Netherlands.
Eur J Cardiothorac Surg. 2024 Nov 28;66(6). doi: 10.1093/ejcts/ezae435.
Mitral regurgitation due to anterior mitral leaflet lesions is associated with an increased risk of mitral regurgitation recurrence after mitral valve repair compared with posterior leaflet-related lesions. Both edge-to-edge (E-to-E) and neochordal repair, associated with ring annuloplasty, have been used in our institution to address isolated anterior mitral leaflet lesions. The aim of this study was to compare the clinical and echocardiographic long-term results of those two approaches for isolated anterior mitral leaflet lesions by means of a propensity match analysis.
An institutional database retrospective review within the time-frame 2000 to 2021 was carried out. The Kaplan-Meier method and cumulative incidence function were employed. Cox regression was used to identify the risk factor for mortality during the follow-up.
The estimated freedom from reoperative mitral valve surgery at 20 years was 78% in the E-to-E group and 64% in the neochordae group (P = 0.032). The longitudinal analysis performed to analyse the mitral regurgitation recurrence rate showed a higher rate of mitral regurgitation ≥3+ recurrence in the neochordae group at 5 (5.1% vs 8.7%), -10 (8.2% vs 13.2%), and 15 years (8.8% vs 16.5%) (P < 0.001).
Isolated anterior leaflet pathology can be effectively treated with E-to-E or neochordal repair and ring annuloplasty. In our series, clinical and echocardiographic results were better in E-to-E group. The excellent durability of this technique up to 20 years of follow-up, together with its simplicity and reproducibility, confirms the role the E-to-E techniques as an excellent treatment option for severe mitral regurgitation due anterior mitral leaflets lesions.
与后叶相关病变相比，二尖瓣前叶病变导致的二尖瓣反流在二尖瓣修复术后二尖瓣反流复发风险增加。在我们机构，边缘对边缘（E-to-E）修复和新腱索修复联合瓣环成形术已被用于处理孤立的二尖瓣前叶病变。本研究的目的是通过倾向匹配分析比较这两种方法治疗孤立二尖瓣前叶病变的临床和超声心动图长期结果。
对2000年至2021年期间的机构数据库进行回顾性研究。采用Kaplan-Meier法和累积发病率函数。使用Cox回归确定随访期间死亡的危险因素。
E-to-E组20年再次进行二尖瓣手术的估计自由度为78%，新腱索组为64%（P = 0.032）。分析二尖瓣反流复发率的纵向分析显示，新腱索组在5年（5.1%对8.7%）、10年（8.2%对13.2%）和15年（8.8%对16.5%）时二尖瓣反流≥3+复发率更高（P < 0.001）。
孤立的前叶病变可通过E-to-E或新腱索修复及瓣环成形术有效治疗。在我们的系列研究中，E-to-E组的临床和超声心动图结果更好。该技术在长达20年的随访中具有出色的耐久性，以及其简单性和可重复性，证实了E-to-E技术作为二尖瓣前叶病变导致的严重二尖瓣反流的优秀治疗选择的作用。
