Dębski Maciej, Qadri Syed, Bhalraam U, Dębska Karolina, Vassiliou Vassilios, Zacharias Joseph
Lancashire Cardiac Centre, Blackpool Teaching Hospitals NHS Foundation Trust, Whinney Heys Rd, Blackpool FY3 8NP, UK.
Norwich Medical School, University of East Anglia, Norwich NR4 7TJ, UK.
Eur Heart J Qual Care Clin Outcomes. 2025 Aug 11;11(5):587-603. doi: 10.1093/ehjqcco/qcae108.
Mitral regurgitation (MR) is a prevalent valvular abnormality categorized as primary or secondary based on aetiology. Surgical intervention, particularly mitral valve repair, is often preferred over replacement due to its association with better outcomes. However, the benefits of repair vs. replacement, especially in secondary MR, remain debated.
This study aims to evaluate the long-term survival and reoperation rates in patients undergoing mitral valve repair compared to mitral valve replacement for MR in a cardiothoracic surgery unit in North-West England and in subgroups with degenerative and secondary aetiology.
We analysed 1724 eligible patients undergoing first-time mitral valve surgery (repair: n = 1243; replacement: n = 481) between 2000 and 2021. The primary outcome was all-cause mortality. Genetic matching and overlap weighting were used to balance baseline characteristics. Median follow-up was 7.1 years. In the matched cohort, mitral valve replacement was associated with higher rates of blood transfusion (29% vs. 22%), longer Intensive Care Unit (ICU) stays, and more strokes (3.7% vs. 0.4%). While 90-day mortality did not differ significantly between groups, long-term follow-up showed a survival advantage for repair [Hazard ratio: 1.32, 95% confidence interval: 1.08-1.63]. Although repair had higher reoperation rates (4.3% vs. 2.1%), the composite of death or reoperation did not differ significantly. In the degenerative MR subgroup, repair showed superior long-term survival, whereas in secondary MR, no significant survival difference was observed between strategies.
Among patients suitable for either surgical strategy, mitral valve repair showed better long-term survival compared to replacement, particularly in degenerative MR. However, this advantage was not observed in secondary MR.
二尖瓣反流（MR）是一种常见的瓣膜异常，根据病因可分为原发性或继发性。由于手术干预，尤其是二尖瓣修复术与更好的预后相关，因此通常比瓣膜置换术更受青睐。然而，修复术与置换术的益处，尤其是在继发性MR中，仍存在争议。
本研究旨在评估在英格兰西北部的心胸外科病房中，接受二尖瓣修复术与二尖瓣置换术治疗MR的患者的长期生存率和再次手术率，并在退行性和继发性病因的亚组中进行比较。
我们分析了2000年至2021年间1724例首次接受二尖瓣手术的符合条件的患者（修复术：n = 1243；置换术：n = 481）。主要结局是全因死亡率。采用遗传匹配和重叠加权来平衡基线特征。中位随访时间为7.1年。在匹配队列中，二尖瓣置换术与更高的输血率（29%对22%）、更长的重症监护病房（ICU）住院时间以及更多的中风发生率（3.7%对0.4%）相关。虽然两组之间90天死亡率无显著差异，但长期随访显示修复术具有生存优势[风险比：1.32，95%置信区间：1.08 - 1.63]。尽管修复术的再次手术率较高（4.3%对2.1%），但死亡或再次手术的复合结局无显著差异。在退行性MR亚组中，修复术显示出更好的长期生存率，而在继发性MR中，两种策略之间未观察到显著的生存差异。
在适合两种手术策略的患者中，二尖瓣修复术与置换术相比显示出更好的长期生存率，尤其是在退行性MR中。然而，在继发性MR中未观察到这种优势。
