Qamar Younus, Schaff Hartzell V, Geske Jeffrey B, Dearani Joseph A, Bagameri Gabor, 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 3. doi: 10.1016/j.jtcvs.2025.03.032.
In patients with obstructive hypertrophic cardiomyopathy and degenerative mitral regurgitation, some advocate valve replacement because it addresses both valve disease and outflow tract obstruction. To avoid late prosthesis-related complications, we have favored septal myectomy and concomitant mitral valve repair, and the present study assesses the outcomes of this approach.
Among 3029 patients with obstructive hypertrophic cardiomyopathy undergoing septal myectomy, 120 received concomitant mitral valve repair for leaflet prolapse. Patients were matched by propensity score to those undergoing mitral valve repair for isolated degenerative mitral regurgitation.
Patients' median age was 63.7 years, and 35.6% were female. Preoperatively, patients with obstructive hypertrophic cardiomyopathy were less likely to have grade 2+ or greater mitral regurgitation (87.6% vs 100%, P < .001). Patients with obstructive hypertrophic cardiomyopathy more often required leaflet plication or Alfieri sutures, whereas those with isolated degenerative mitral regurgitation were more likely to undergo leaflet resections and artificial neochordae placement. Mitral annuloplasty was performed less frequently in patients with obstructive hypertrophic cardiomyopathy (60.0% vs 99.2%, P < .001). Early morbidity and mortality were comparable, with 1 (0.8%) death in each group. There were no significant differences in late survival (10 years, 79% for obstructive hypertrophic cardiomyopathy vs 82% for isolated degenerative mitral regurgitation, P = .85). Recurrence of severe mitral regurgitation at 10 years was similar between groups (10.2% for obstructive hypertrophic cardiomyopathy vs 6.5% isolated degenerative mitral regurgitation, P = .61), as was the rate of mitral valve reoperation (5.5% vs 2.7%, P = .79).
Mitral valve repair for concomitant degenerative mitral regurgitation in patients with obstructive hypertrophic cardiomyopathy is feasible, safe, and durable, with similar survival and reoperation rates to those of patients with isolated degenerative mitral regurgitation.
在患有梗阻性肥厚型心肌病和退行性二尖瓣反流的患者中，一些人主张进行瓣膜置换，因为它能同时解决瓣膜疾病和流出道梗阻问题。为避免晚期人工瓣膜相关并发症，我们更倾向于行室间隔心肌切除术并同期进行二尖瓣修复，本研究评估了这种方法的效果。
在3029例接受室间隔心肌切除术的梗阻性肥厚型心肌病患者中，120例因瓣叶脱垂接受了同期二尖瓣修复。通过倾向评分将患者与因单纯退行性二尖瓣反流接受二尖瓣修复的患者进行匹配。
患者的中位年龄为63.7岁，35.6%为女性。术前，梗阻性肥厚型心肌病患者出现2+级或更严重二尖瓣反流的可能性较小（87.6%对100%，P<.001）。梗阻性肥厚型心肌病患者更常需要瓣叶折叠或阿尔菲耶里缝合，而单纯退行性二尖瓣反流患者更可能接受瓣叶切除和人工腱索植入。梗阻性肥厚型心肌病患者进行二尖瓣环成形术的频率较低（60.0%对99.2%，P<.001）。早期发病率和死亡率相当，每组各有1例（0.8%）死亡。晚期生存率无显著差异（10年时，梗阻性肥厚型心肌病患者为79%，单纯退行性二尖瓣反流患者为82%，P=.85）。两组间10年时严重二尖瓣反流的复发率相似（梗阻性肥厚型心肌病患者为10.2%，单纯退行性二尖瓣反流患者为6.5%，P=.61），二尖瓣再次手术率也相似（5.5%对2.7%，P=.79）。
梗阻性肥厚型心肌病患者同期行退行性二尖瓣反流的二尖瓣修复是可行、安全且持久的，其生存率和再次手术率与单纯退行性二尖瓣反流患者相似。
