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Title: [Efficacy of mitral valve repair versus replacement in severe ischemic mitral regurgitation].
Author: Qiu ZB, Chen X, Xu M, Jiang YS, Wang LM, Huang FH, Liu PS, Wang R, Xiang F, Shao JJ, Qin W.
Journal: Zhonghua Yi Xue Za Zhi; 2017 Jun 13; 97(22):1705-1709. PubMed ID: 28606278.
Abstract:
Objective: To compare the mortality, survival rate and the therapeutic efficacy between mitral valve repair and replacement as treatment for severe ischemic mitral regurgitation (IMR), and explore the middle- and long-term outcomes. Methods: Between January 2000 and January 2016, 378 patients with severe IMR underwent coronary artery bypass grafting (CABG) combined with mitral valve repair (n=162) or mitral valve replacement (n=216) in the Department of Cardiovascular Surgery of Nanjing First Hospital. Clinical data, in-hospital morbidity and mortality of patients were retrospectively reviewed. The patients were followed up for the long term survival rate, heart function and re-admission. Results: No statistically significant differences of baseline data and operation details were found between the two groups except for left ventricular end-diastolic diameter[(61.3±10.2)mm in replacement group vs (56.2±9.0)mm in repair group, P<0.001]. Seven patients died during the perioperative period, with a total operation mortality of 1.9%.No significant difference of mortality was found between the two groups (5 cases in the replacement group and 2 cases in the repair group). The early outcome after the surgery showed that the rate of low cardiac output and ventricular arrhythmia of patients were significantly higher in the replacement group compared with the repair group (both P<0.05). The mortality of patients received mitral valve replacement was better than who received mitral valve repair when left ventricular end-diastolic diameter was over 65 mm (5.9% vs 10.0%, P=0.036). No significant differences were observed between the two groups in the middle- and -long term survival rate (87% for replacement group vs 85% for repair group, P=0.568). The follow-up time was 1-85 (52.8±21.5) months and the follow-up rate was 93%. The rate of valve-related complications was significantly higher in the repair group compared with the replacement group (8.82% vs 3.82%, P=0.003). Conclusions: We should choose the surgical methods carefully (replacement or repair) for severe IMR patients according to degree of left ventricular remodeling and pathological changes of mitral valve. Mitral valve replacement with preservation of the subvalvular apparatus is a safe and effective surgical alternative for mitral valve repair, especially for patients with complications or complex reflux. 目的： 观察二尖瓣修复术或二尖瓣置换术治疗重度缺血性二尖瓣反流(IMR)的临床结果、病死率和生存率，评估重度IMR的中远期疗效。 方法： 2000年1月至2016年1月，南京市第一医院心血管外科共对378例冠心病并重度IMR的患者进行外科二尖瓣修复或置换手术治疗，其中男215例，女163例，年龄36～79岁(65.7±9.5)岁，二尖瓣修复术组162例，二尖瓣置换术组216例。回顾性分析患者临床资料、围手术期事件，随访观察长期生存率及心功能状况、反流矫治情况。 结果： 置换组左心室舒张末期内径大于修复组[(61.3±10.2)mm比(56.2±9.0)mm，P<0.001]，其余基线资料及手术情况方面两组差异均无统计学意义(均P>0.05)。围手术期死亡7例(1.9%)，其中置换组5例，修复组2例，两组手术病死率差异无统计学意义(P＝0.700)；术后早期结果显示置换组的术后低心排出量综合征、室性心律失常发生率高于修复组(均P<0.05)；对于左心室舒张末期内径≥65 mm患者手术病死率，置换组低于修复组(5.9%比10.0%，P＝0.036)。术后随访1～85(52.8±21.5)个月，随访率93%。置换组与修复组的总体中远期生存率差异无统计学意义(87%比85%，P＝0.568)；二尖瓣修复组瓣膜相关并发症发生率高于置换组(8.82%比3.82%，P＝0.003)。 结论： 重度IMR行二尖瓣修复术还是置换术应根据患者左心室重构、二尖瓣病变的程度谨慎选择。保留瓣下装置的二尖瓣置换术是一种有效替代二尖瓣修复术的手术方式，特别适合于有合并症及复杂反流患者。.

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