Early mitral valve surgery for chronic severe mitral regurgitation optimizes left ventricular performance and left ventricular mass regression
Early mitral valve surgery for chronic severe mitral regurgitation optimizes left ventricular performance and left ventricular mass regression
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DOI：
10.1016/j.jtcvs.2012.05.056
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发表时间：
2013-07-01
影响因子：
6
通讯作者：
Ueda, Tomohiro
中科院分区：
文献类型：
--
作者：
Imasaka, Ken-ichi;Tomita, Yukihiro;Ueda, Tomohiro
目的：重度二尖瓣返流的最佳二尖瓣手术时机存在争议。我们的目的是利用心室能量学和左心室质量回归来评估手术后左心室功能的变化，以确定无症状的严重二尖瓣反流患者的合适手术时机。方法：回顾性分析50例选择性行严重二尖瓣反流手术的连续无症状或轻度症状患者。术前和术后1个月超声心动图测量收缩力（收缩末期弹性）、负荷后（有效动脉弹性）、效率（心室动脉耦合及卒中功与压力-容积面积之比）和左心室质量指数。采用双向重复测量方差分析比较左心室功能障碍患者（n = 17）和非左心室功能障碍患者（n = 33）（即射血分数= 40 mm）的参数。结果：两组的收缩力无明显变化（P = 0.94），但后负荷明显增加（P < 0.0001）。因此，效率显著下降（脑室-动脉耦合，P = 0.0004；卒中功与压力-容积面积之比，P < 0.0001）。两组患者左心室质量指数均显著改善（P < 0.0001）。而左心室功能正常的患者术后收缩力更大（P < 0.0001），效率更低（分别P < 0.0001和P < 0.0001），左心室质量指数更好（P = 0.0002）。结论：早期手术治疗严重二尖瓣反流可保留左心室功能，改善无症状心室功能正常患者的左心室质量退化。
Objective: The optimal timing of mitral valve surgery for severe mitral regurgitation is controversial. We aimed to evaluate the changes in left ventricular performance using ventricular energetics and left ventricular mass regression after the surgery to determine the appropriate surgical timing in asymptomatic patients with severe mitral regurgitation.Methods: Fifty consecutive asymptomatic or minimally symptomatic patients who electively underwent the surgery for severe mitral regurgitation were studied retrospectively. Contractility (end-systolic elastance), after-load (effective arterial elastance), and efficiency (ventriculoarterial coupling and ratio of stroke work to pressure-volume area), and left ventricular mass index were measured echocardiographically before and 1 month after surgery. Two-way repeated-measures analysis of variance was used to compare the parameters between patients with (n = 17) and without (n = 33) left ventricular dysfunction (ie, ejection fraction = 40 mm).Results: Contractility did not change significantly (P = .94) but the afterload increased significantly (P < .0001) in both groups. Consequently, the efficiency deteriorated significantly (ventriculoarterial coupling, P = .0004; ratio of stroke work to pressure-volume area, P < .0001). Furthermore, the left ventricular mass index improved remarkably in both groups (P < .0001). Alternatively, the patients with normal left ventricular function had greater contractility (P < .0001), less worsened efficiency (P < .0001 and P < .0001, respectively), and a better left ventricular mass index (P = .0002) after surgery.Conclusions: Early surgery for severe mitral regurgitation preserves left ventricular performance and improves left ventricular mass regression in asymptomatic patients with normal ventricular function.