Predictors of ischemic mitral regurgitation improvement after surgical revascularization plus mitral valve repair for moderate ischemic mitral regurgitation
Predictors of ischemic mitral regurgitation improvement after surgical revascularization plus mitral valve repair for moderate ischemic mitral regurgitation
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DOI：
10.1111/jocs.14455
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发表时间：
2020-02-04
影响因子：
1.6
通讯作者：
Wang, ChunSheng
中科院分区：
文献类型：
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作者：
Ji, Qiang;Zhao, Yun;Wang, ChunSheng
背景和目的冠状动脉旁路移植术（CABG）和二尖瓣修复术后缺血性二尖瓣返流（IMR）复发确实存在，在2- 4年随访时的患病率为20%-30%。本单中心研究旨在探讨中度IMR.Methods201例患者根据术后2年是否发生中度或重度二尖瓣返流分为改良组（n = 141）和对照组（n = 60）。结果两组患者左室舒张末期内径（LVEDD）、左室环类型、左室舒张末期内径（LVEDD）（刚性完整环），以及修复技术的使用（与瓣下和/或瓣叶修复相关的限制性瓣环成形术）是术后IMR改善的三个预测因素（比值比[OR] = 0.921，95%可信区间[CI]，0.865-0.976，P = .025; OR = 7.753，95% CI，3.168-17.742，P < .001; OR = 0.168，95%CI为0.076-0.423，P = 0.004）。LVEDD的临界值为65 mm，敏感性为80.0%，特异性为65.2%。与对照组相比，改善组患者在中位随访41.0个月期间表现出更好的累积生存率（chi（2）= 4.559，logrank P = 0.033），并且在最后一次随访时纽约心脏协会III-IV级的比率降低结论左室舒张末内径小于65 mm、使用刚性成形环、限制性瓣环成形术联合瓣下和/或瓣叶修复术与CABG+二尖瓣修复术治疗中度IMR后IMR改善相关;术后2年IMR改善与中期结局改善相关。
Background and Aim Ischemic mitral regurgitation (IMR) recurrence after combined coronary artery bypass grafting (CABG) and mitral valve repair does occur, with a prevalence of 20% to 30% at the 2- to 4-year follow-up. This single-center study aims to identify the predictors of IMR improvement after surgical revascularization plus mitral valve repair for moderate IMR.Methods A total of 201 eligible patients were entered into an improved group (n = 141) or a control group (n = 60) according to whether moderate or more mitral regurgitation occurred at the 2-year postoperative time point. Clinical outcomes between groups were compared.Results The left ventricular endo-diastolic diameter (LVEDD), type of ring (rigid complete ring), and the use of repair techniques (restrictive annuloplasty associated with subvalvular and/or leaflet repair) were three predictors of IMR improvement after surgery (odds ratio [OR] = 0.921, 95% confidence interval [CI], 0.865-0.976, P = .025; OR = 7.753, 95% CI, 3.168-17.742, P < .001; and OR = 0.168, 95% CI, 0.076-0.423, P = .004, respectively). The cutoff value of the LVEDD was 65 mm with a sensitivity of 80.0% and a specificity of 65.2%. Patients in the improved group compared with those in the control group demonstrated better cumulative survival during a median follow-up of 41.0 months (chi(2) = 4.559, logrank P = .033) and a reduced ratio of the New York Heart Association class III-IV at the latest follow-up (5.7% vs 38.4%, P < .001).Conclusions An LVEDD of less than 65 mm, the use of a rigid complete ring, and combined restrictive annuloplasty and subvalvular and/or leaflet repair are associated with IMR improvement after CABG plus mitral valve repair for the treatment of moderate IMR; IMR improvement 2 years after surgery is associated with improved midterm outcomes.