Trends in Mitral Valve Surgery in the United States: Results From The Society of Thoracic Surgeons Adult Cardiac Database
Trends in Mitral Valve Surgery in the United States: Results From The Society of Thoracic Surgeons Adult Cardiac Database
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DOI：
10.1016/j.athoracsur.2009.01.064
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发表时间：
2009-05-01
影响因子：
4.6
通讯作者：
Brown, James M.
中科院分区：
文献类型：
--
作者：
Gammie, James S.;Sheng, Shubin;Brown, James M.
背景。本研究的目的是利用胸外科医生协会成人心脏手术数据库 (STS ACSD) 研究二尖瓣 (MV) 修复和置换手术的趋势。方法。研究人群包括 2000 年 1 月至 2007 年 12 月期间在参与 STS ACSD 的 910 家医院进行的孤立二尖瓣手术。患有心内膜炎、既往心脏手术、休克、急诊手术以及同时进行冠状动脉搭桥术或主动脉瓣手术的患者被排除。 结果。在为期 8 年的研究期间，58,370 名患者接受了单独的初次 MV 手术。对于孤立性二尖瓣关闭不全的患者 (n = 47,126)，二尖瓣修复率（相对于置换）从 51% 增加到 69% (p < 0.0001)。在进行置换的患者中 (n = 24,404)，机械瓣膜的使用率显着下降：68% 至 37% (p < 0.0001)。 MV 置换的手术死亡率始终高于修复的手术死亡率（3.8% 对比 1.4%），这一发现在风险调整后仍然存在（调整后的比值比 0.52，95% 置信区间：0.45 至 0.59；p < 0.0001）。在接受选择性孤立 MV 修复的患者 (n = 28,140) 中，手术死亡率为 1.2%。对于无症状（I 类）患者，手术死亡率为 0.6%。结论。这项研究记录了二尖瓣手术的几个重要趋势，包括二尖瓣修复术的逐渐采用和生物假体置换瓣膜的使用增加。中膜修复的手术风险明显低于中膜置换的手术风险。在当代临床实践中，孤立选择性二尖瓣修复术的手术死亡率为 1%。
Background. The purpose of this study is to examine trends in mitral valve (MV) repair and replacement surgery using The Society of Thoracic Surgeons Adult Cardiac Surgery Database (STS ACSD).Methods. The study population included isolated mitral valve operations performed between January 2000 and December 2007 at 910 hospitals participating in the STS ACSD. Patients with endocarditis, prior cardiac operation, shock, emergency operation, and concomitant coronary artery bypass graft or aortic valve surgery were excluded.Results. During the 8-year study period, 58,370 patients underwent isolated primary MV operations. For patients with isolated mitral regurgitation (n = 47,126), the rate of MV repair (versus replacement) increased from 51% to 69% (p < 0.0001). Among patients having replacement (n = 24,404), there has been a pronounced decline in the use of mechanical valves: 68% to 37% (p < 0.0001). The operative mortality for MV replacement was consistently higher than that for repair (3.8% versus 1.4%), a finding that persisted after risk-adjustment (adjusted odds ratio 0.52, 95% confidence interval: 0.45 to 0.59; p < 0.0001). Among patients having elective isolated MV repair (n = 28,140), the operative mortality was 1.2%. For asymptomatic (class I) patients, operative mortality was 0.6%.Conclusions. This study documents several important trends in MV surgery, including the progressive adoption of mitral valve repair and increasing use of bioprosthetic replacement valves. Operative risks of MV repair are significantly lower than those for MV replacement. Operative mortality for isolated elective mitral valve repair is 1% in contemporary clinical practice.