Qamar Younus, Schaff Hartzell V, Geske Jeffrey B, Dearani Joseph A, Giudicessi John R, Todd Austin, Ommen Steve R
Department of Cardiovascular Surgery, Mayo Clinic, Rochester, Minn.
Department of Cardiovascular Surgery, Mayo Clinic, Rochester, Minn.
J Thorac Cardiovasc Surg. 2025 May 2. doi: 10.1016/j.jtcvs.2025.03.033.
To evaluate the impact of residual mitral valve (MV) regurgitation (MR) in patients with obstructive hypertrophic cardiomyopathy immediately after myectomy on late survival and the risk of MV reintervention.
From October 2001 to February 2024, 3061 patients with hypertrophic cardiomyopathy and dynamic left ventricular outflow tract obstruction underwent septal myectomy. A 1:1 propensity score matching was performed between patients with mild or trivial/no residual MR immediately after cardiopulmonary bypass and patients with moderate or greater residual MR. Long-term survival, MR progression, and the incidence of MV reintervention were analyzed.
Postbypass moderate or greater residual MR was present in 398 patients (13.9%). Matching yielded 398 pairs, with no differences in age (62.1 years vs 61.9 years, P = .397), nor in median peak left ventricular outflow tract gradient on predismissal echocardiography (3 [0-9] mm Hg vs 3 [0-10] mm Hg, P = .585). Late incidence of moderate-severe or greater MR was greater in those with residual MR (15 years: 48.0% vs 11.9%, P = .002), and the incidence of subsequent MV intervention at 15 years was 3-fold greater in those with intraoperative residual MR (14.0% vs 3.9%, P = .007). However, the overall survival of the 2 groups was similar (P = .48).
Residual MR after septal myectomy is not associated with early or late mortality. However, beyond 5 years' postoperatively, patients with moderate or greater residual MR experience accelerated rates of recurrent MR and require MV reintervention. Residual MR may be attributable to unrecognized mild intrinsic MV disease that progresses late postoperatively.
评估梗阻性肥厚型心肌病患者在心肌切除术后即刻残留二尖瓣反流（MR）对远期生存及二尖瓣再次干预风险的影响。
2001年10月至2024年2月，3061例肥厚型心肌病合并动态左心室流出道梗阻患者接受了室间隔心肌切除术。对体外循环后轻度或微量/无残留MR患者与中度或更严重残留MR患者进行1:1倾向评分匹配。分析长期生存、MR进展及二尖瓣再次干预的发生率。
体外循环后398例患者（13.9%）存在中度或更严重残留MR。匹配产生398对，年龄无差异（62.1岁 vs 61.9岁，P = 0.397），出院前超声心动图检查时左心室流出道峰值梯度中位数也无差异（3[0 - 9]mmHg vs 3[0 - 10]mmHg，P = 0.585）。残留MR患者中重度或更严重MR的晚期发生率更高（15年时：48.0% vs 11.9%，P = 0.002），术中残留MR患者15年时后续二尖瓣干预的发生率高出3倍（14.0% vs 3.9%，P = 0.007）。然而，两组的总体生存率相似（P = 0.48）。
室间隔心肌切除术后残留MR与早期或晚期死亡率无关。然而，术后5年以上，中度或更严重残留MR的患者复发性MR发生率加快，需要二尖瓣再次干预。残留MR可能归因于未被识别的轻度内在二尖瓣疾病，其在术后晚期进展。
