Pollari Francesco, Liang Huan, Vogt Ferdinand, Ledwon Miroslaw, Weber Lucia, Sirch Joachim, Bagaev Erik, Fittkau Matthias, Fischlein Theodor
Department of Cardiac Surgery, Klinikum Nürnberg-Paracelsus Medical University, Breslauer Strasse 201, 90471 Nuremberg, Germany.
J Clin Med. 2024 Nov 24;13(23):7097. doi: 10.3390/jcm13237097.
In recent years, the use of transcatheter valve-in-valve implantation in the mitral position (TMVI) for the treatment of mitral valve pathology following ring or bioprosthetic implantation has emerged as a less invasive option in comparison to repeated mitral valve surgery (RMVS). We aimed to compare the early and mid-term results of these two strategies. We retrospectively analyzed all patients who underwent a mitral intervention in our institution between 2005 and 2022. Applying the exclusion criteria, 41 subjects were analyzed: 23 underwent RMVS, while 18 underwent a TMVI. The time-dependency treatment effect was approached using a landmark analysis, applying the Kaplan-Meier analysis at different time points. The two study groups were comparable in terms of age ( = 0.18), gender ( = 0.78), body surface area ( = 0.33), and EuroSCORE II ( = 0.06). No patients died perioperatively or had a stroke. Two patients in each group died within the first 30 days following the procedure (RMVS 8.3% vs. TMVI 11.1%; = 0.75). Eighteen patients had died at follow-up; two underwent re-intervention on their mitral valve (one in each group). The mean survival was not statistically different between groups (RMVS 8 ± 1.1 years, 95% CI 5.8-10.2, vs. TMVI 4.79 ± 0.82 years, 95% CI 3.1-6.4; log-rank = 0.087). A landmark analysis of survival after four years showed significantly worse survival for patients in the TMVI group in comparison with those treated surgically (log-rank = 0.047). TMVI and RMVS are both effective strategies with similar short-term outcomes. However, patients in the TMVI group showed a significantly lower survival rate after four years.
近年来，经导管二尖瓣瓣中瓣植入术（TMVI）用于治疗二尖瓣环或生物瓣膜植入术后的二尖瓣病变，与再次二尖瓣手术（RMVS）相比，已成为一种侵入性较小的选择。我们旨在比较这两种策略的早期和中期结果。我们回顾性分析了2005年至2022年在我们机构接受二尖瓣介入治疗的所有患者。应用排除标准后，分析了41名受试者：23例行RMVS，18例行TMVI。采用地标性分析方法探讨时间依赖性治疗效果，在不同时间点应用Kaplan-Meier分析。两个研究组在年龄（P = 0.18）、性别（P = 0.78）、体表面积（P = 0.33）和欧洲心脏手术风险评估系统II（P = 0.06）方面具有可比性。没有患者在围手术期死亡或发生中风。每组各有两名患者在术后30天内死亡（RMVS组为8.3%，TMVI组为11.1%；P = 0.75）。18名患者在随访时死亡；两名患者接受了二尖瓣再次干预（每组各一名）。两组之间的平均生存期无统计学差异（RMVS组为8 ± 1.1年，95%置信区间为5.8 - 10.2年，TMVI组为4.79 ± 0.82年，95%置信区间为3.1 - 6.4年；对数秩检验P = 0.087）。对四年后的生存情况进行地标性分析显示，与接受手术治疗的患者相比，TMVI组患者的生存率明显更差（对数秩检验P = 0.047）。TMVI和RMVS都是有效的策略，短期结果相似。然而，TMVI组患者在四年后的生存率明显较低。
