Engler Clemens, Pölzl Leo, Nägele Felix, Graber Michael, Hirsch Jakob, Lohmann Ronja, Holfeld Johannes, Dumfarth Julia, Spilka Johannes, Müller Ludwig, Grimm Michael, Höfer Daniel, Gollmann-Tepeköylü Can, Bonaros Nikolaos
Department of Cardiac Surgery, Medical University of Innsbruck, Innsbruck, Austria.
Interdiscip Cardiovasc Thorac Surg. 2025 Sep 27;40(10). doi: 10.1093/icvts/ivaf213.
Commissural prolapse (CP) is a rare and complex mitral valve pathology which is complicated in preoperative diagnosis and repair. This study evaluated the safety, success, and long-term efficacy of minimally invasive mitral valve repair (MIMVR) for CP compared to posterior leaflet prolapse (PMLp).
Between 2001 and 2022, 34 patients with CP and 590 with PMLp underwent MIMVR at our center. Operative, perioperative, and long-term follow-up data were retrospectively collected. Surgical success was defined as freedom from conversion to valve replacement, sternotomy, and residual mitral regurgitation (MR) > grade I. Long-term efficacy included MR recurrence, reoperation, and survival.
Median age was similar (CP: 64.0 years [53.2; 69.8] vs PMLp: 62.0 years [53.0; 69.0], p = 0.783). Barlow's disease was more frequent in PMLp (80.3% vs 32.4%, p < 0.001). Cross-clamp (127.0 min vs 105.0 min, p = 0.001) and bypass times (208.5 min vs 190.5 min, p = 0.031) were longer in CP. CP patients had longer hospital stays (10.0 days [8.0; 12.0] vs 8.0 days [7.0; 9.0], p < 0.001), but short-term outcomes, including 30-day mortality, stroke, and ECMO support, were comparable. At a median follow-up of 4.5 years (CP) and 2.4 years (PMLp, p = 0.001), rates of recurrent MR, reoperation, and survival were similar.
MIMVR for CP is safe, successful, and durable with outcomes comparable to PMLp. Despite greater technical complexity and longer operative times, this approach provides reliable results for CP.
连合部脱垂（CP）是一种罕见且复杂的二尖瓣病变，术前诊断和修复都很困难。本研究评估了与后叶脱垂（PMLp）相比，微创二尖瓣修复术（MIMVR）治疗CP的安全性、成功率和长期疗效。
2001年至2022年期间，34例CP患者和590例PMLp患者在本中心接受了MIMVR。回顾性收集手术、围手术期和长期随访数据。手术成功定义为无需转为瓣膜置换、开胸手术，且残余二尖瓣反流（MR）>Ⅰ级。长期疗效包括MR复发、再次手术和生存率。
中位年龄相似（CP：64.0岁[53.2；69.8] vs PMLp：62.0岁[53.0；69.0]，p = 0.783）。Barlow病在PMLp中更常见（80.3% vs 32.4%，p < 0.001）。CP患者的主动脉阻断时间（127.0分钟 vs 105.0分钟，p = 0.001）和体外循环时间（208.5分钟 vs 190.5分钟，p = 0.031）更长。CP患者的住院时间更长（10.0天[8.0；12.0] vs 8.0天[7.0；9.0]，p < 0.001），但包括30天死亡率、中风和体外膜肺氧合（ECMO）支持在内的短期结局相当。在CP组中位随访4.5年和PMLp组中位随访2.4年时（p = 0.001），MR复发率、再次手术率和生存率相似。
MIMVR治疗CP是安全、成功且持久的，其结果与PMLp相当。尽管技术复杂性更高且手术时间更长，但这种方法为CP提供了可靠的结果。
