二尖瓣乳头肌破裂的修复与置换：一项多中心研究

Repair Versus Replacement in Mitral Valve Papillary Muscle Rupture: A Multicenter Study.

作者信息

Massimi Giulio, Matteucci Matteo, De Bonis Michele, Kowalewski Mariusz, Formica Francesco, Russo Claudio Francesco, Sponga Sandro, Vendramin Igor, Colli Andrea, Falcetta Giosuè, Trumello Cinzia, Carrozzini Massimiliano, Fischlein Theodor, Troise Giovanni, Dato Guglielmo Actis, D'Alessandro Stefano, Nia Peyman Sardari, Lodo Vittoria, Villa Emmanuel, Shah Shabir Hussain, Scrofani Roberto, Binaco Irene, Kalisnik Jurij Matija, Dell'Uomo Marco, Pettinari Matteo, Thielmann Matthias, Meyns Bart, Khouqeer Fareed A, Fino Carlo, Simon Caterina, Musazzi Andrea, Kowalowka Adam, Deja Marek A, Pisani Angelo, Batko Jakub, Borghetti Valentino, Ronco Daniele, Di Mauro Michele, Lorusso Roberto

机构信息

Department of Cardiothoracic Surgery, Heart and Vascular Centre, Maastricht University Medical Centre, Maastricht, 6221, The Netherlands.

Cardiothoracic and Vascular Department, Santa Maria Hospital, Terni, Italy.

出版信息

Eur J Cardiothorac Surg. 2025 Sep 2;67(9). doi: 10.1093/ejcts/ezaf284.

DOI:10.1093/ejcts/ezaf284

PMID:40845148

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC12417086/

Abstract

OBJECTIVES

Papillary muscle rupture (PMR) is a rare but potentially fatal mechanical complication after acute myocardial infarction (AMI). Although surgery is considered the gold-standard treatment for post-AMI PMR, the optimal surgical strategy remains unclear.

METHODS

Data from post-AMI PMR patients submitted to mitral valve replacement (MVR) or mitral valve repair (MVr) surgery in the period between 2001 and 2019, from 20 international centres, were collected in the CAUTION study database. In-hospital and long-term post-discharge mortality were the endpoints. A multivariable logistic regression model was used to determine mortality independent factors.

RESULTS

The patient cohort available included 218 patients. MVR was the most frequent type of surgery (81.6%). Complete PMR was more common in the MVR group (71.9%, P = .008), while partial PMR was more frequent in MVr patients (75%, P = .008). In-hospital mortality rate was 25.8% in the MVR subgroup and 20% in MVr subjects (P = .440). In MVR subgroup, concomitant coronary artery bypass grafting (CABG) was associated with lower in-hospital mortality (n = 20/96, 21%) than no concomitant CABG (31.7%, P = .035). Survival at 1, 3, 5, and 10 years was 59.3%, 55.9%, 53.1%, 46.9% in the MVR group and 59.9%, 56.8%, 54.1%, and 43.2% in MVr patients, respectively, with no statistical differences (P = .474). Patients underwent MVr surgery, and 1-, 3-, 5-, and 10-year survival was 79.8%, 75.4%, 68.5%, and 37.5%, respectively, when CABG revascularization was performed, while no CABG survival was 16.7%, 16.7%, 8.3%, and 8.3% (P < .001).

CONCLUSIONS

MVR is the most commonly performed in complete post-AMI PMR and MVr in partial PMR. No differences were observed regarding in-hospital and long-term mortality in the 2 surgical groups, and no independent factors were associated with overall mortality. Concomitant CABG was associated with higher in-hospital survival.

CLINICAL REGISTRATION NUMBER

Clinicaltrials.gov, NCT03848429.

摘要

目的

乳头肌破裂（PMR）是急性心肌梗死（AMI）后一种罕见但可能致命的机械性并发症。尽管手术被认为是AMI后PMR的金标准治疗方法，但最佳手术策略仍不明确。

方法

在CAUTION研究数据库中收集了2001年至2019年期间来自20个国际中心的接受二尖瓣置换术（MVR）或二尖瓣修复术（MVr）的AMI后PMR患者的数据。住院期间和出院后的长期死亡率为研究终点。使用多变量逻辑回归模型确定死亡率的独立因素。

结果

纳入的患者队列包括218例患者。MVR是最常见的手术类型（81.6%）。完全性PMR在MVR组中更常见（71.9%，P = 0.008），而部分性PMR在MVr患者中更常见（75%，P = 0.008）。MVR亚组的住院死亡率为25.8%，MVr亚组为20%（P = 0.440）。在MVR亚组中，同期进行冠状动脉旁路移植术（CABG）的患者住院死亡率（n = 20/96，21%）低于未同期进行CABG的患者（31.7%，P = 0.035）。MVR组1年、3年、5年和10年的生存率分别为59.3%、55.9%、53.1%、46.9%，MVr患者分别为59.9%、56.8%、54.1%和43.2%，无统计学差异（P = 0.474）。接受MVr手术的患者，进行CABG血运重建时1年、3年、5年和10年生存率分别为79.8%、75.4%、68.5%和37.5%，未进行CABG时生存率为16.7%、16.7%、8.3%和8.3%（P < 0.001）。