Shin Yaerhim, French John K, Mian Mahnoor, Leung Dominic Y, Tran Nguyen Giang Tien, Wolfenden Hugh D, Dignan Rebecca
Cardiothoracic Surgery and Cardiology Departments, Liverpool Hospital, South West Sydney, NSW, Australia; South West Sydney Clinical School, Faculty of Medicine, University of New South Wales, Sydney, NSW, Australia.
Cardiothoracic Surgery and Cardiology Departments, Liverpool Hospital, South West Sydney, NSW, Australia.
Heart Lung Circ. 2025 May;34(5):485-496. doi: 10.1016/j.hlc.2024.11.024. Epub 2025 Feb 17.
Ischaemic mitral regurgitation (IMR) results from dysfunctional myocardial remodelling, which portends a poor clinical prognosis. This study assessed the surgical treatment of IMR and its associations with clinical and echocardiographic outcomes in the context of 2014 reports suggesting non-surgical management of non-severe IMR.
Patients who underwent mitral valve (MV) procedures for IMR at Liverpool Hospital (Sydney, Australia) between 2008 and 2020 were included based on coronary disease and echocardiographic criteria. Data were obtained from patient records and linkage with the Australian Institute of Health and Welfare National Death Index. The primary outcome was the type of MV surgery performed in 2008-2014 and 2015-2020. Secondary outcomes were survival and freedom from combination of mortality and congestive heart failure (CHF) readmission, comparing MV repair and MV replacement and the outcomes for two periods by MV procedure.
Of 106 patients treated surgically for IMR, 78 had MV repair (59 in 2008-2014, 19 in 2015-2020) and 28 had MV replacement (14 in 2008-2014, 14 in 2015-2020). Patients were followed up for 7.2 years (interquartile range 5.2-9.1). Compared to 2008-2014, there was a reduced proportion of MV procedures for IMR (4.2% and 2.0%; p<0.001) and MV repair for IMR (80.8% and 57.6%; p=0.012) post-2014. Freedom from a combination of mortality and CHF readmission over 10 years was significantly better in the MV repair than in the MV replacement group (log rank p<0.001). Over 5 years, freedom from mortality and the combination of mortality and CHF readmission were similar in both periods (log rank p=0.675 and p=0.433). In the earlier period, freedom from combined outcome was better in the MV repair group than the MV replacement group (log rank p<0.001) but not different in the second period (log rank p=0.149). Mitral regurgitation recurrence was less in the later period (25.8% and 3.6%; p=0.013).
The proportion of MV procedures and MV repairs performed for IMR declined significantly after 2014, indicating a significant change in practice towards conservative surgical correction of IMR. The combined long-term outcomes were unchanged after the change in practice, but the incidence of mitral regurgitation recurrence was significantly improved.
缺血性二尖瓣反流（IMR）是由功能失调的心肌重塑引起的，这预示着临床预后不良。2014年的报告表明对非严重IMR采取非手术治疗，本研究评估了IMR的外科治疗及其与临床和超声心动图结果的关联。
根据冠心病和超声心动图标准，纳入2008年至2020年期间在澳大利亚悉尼利物浦医院因IMR接受二尖瓣（MV）手术的患者。数据从患者记录中获取，并与澳大利亚卫生与福利研究所国家死亡指数进行关联。主要结局是2008 - 2014年和2015 - 2020年进行的MV手术类型。次要结局是生存率以及无死亡和充血性心力衰竭（CHF）再入院的组合情况，比较MV修复和MV置换以及按MV手术程序划分的两个时期的结局。
106例接受IMR手术治疗的患者中，78例行MV修复（2008 - 2014年59例，2015 - 2020年19例），28例行MV置换（2008 - 2014年14例，2015 - 2020年14例）。患者随访7.2年（四分位间距5.2 - 9.1年）。与2008 - 2014年相比，2014年后因IMR进行的MV手术比例降低（4.2%和2.0%；p<0.001），因IMR进行的MV修复比例降低（80.8%和57.6%；p = 0.012）。MV修复组10年无死亡和CHF再入院组合的情况显著优于MV置换组（对数秩检验p<0.001）。5年期间，两个时期的无死亡率以及无死亡和CHF再入院组合的情况相似（对数秩检验p = 0.675和p = 0.433）。在早期，MV修复组无联合结局的情况优于MV置换组（对数秩检验p<0.001），但在第二个时期无差异（对数秩检验p = 0.149）。后期二尖瓣反流复发率较低（25.8%和3.6%；p = 0.013）。
2014年后因IMR进行的MV手术和MV修复比例显著下降，表明在IMR保守手术矫正方面的实践发生了重大变化。实践改变后联合长期结局未变，但二尖瓣反流复发率显著改善。
