Preoperative posterior leaflet angle accurately predicts outcome after restrictive mitral valve annuloplasty for ischemic mitral regurgitation
Preoperative posterior leaflet angle accurately predicts outcome after restrictive mitral valve annuloplasty for ischemic mitral regurgitation
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DOI：
10.1161/circulationaha.106.649236
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发表时间：
2007-02-13
期刊：
影响因子：
37.8
通讯作者：
Senechal, Mario
中科院分区：
文献类型：
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作者：
Magne, Julien;Pibarot, Philippe;Senechal, Mario
背景-缺血性二尖瓣返流(MR)在限制性二尖瓣成形术后通常持续存在，在这种情况下与较差的临床结果相关。本研究的目的是确定是否可以通过二尖瓣形态的术前分析来预测MR的持续性和/或临床结果。方法和结果-连续51例因缺血性MR而接受限制性瓣环成形术的患者，术前(6+/-3天)和术后早期(9+/-4天)用超声心动图对MR的后叶角度、前叶角度、吻合距离和帐篷面积进行了量化，并对MR的严重程度进行了评估。术后，11例(22%)患者观察到轻度至中度MR(收缩静脉3 mm)持续存在。预测MR术后持续性的最佳指标为PL角=45度(敏感性100%，特异性97%，阳性预测值92%，阴性预测值100%)。持续性MR患者的3年无事件生存率(26+/-20%)明显低于非持续性MR患者(75+/-12%，P=0.01)。术前PL角45度与3年无事件生存率显著降低相关(22+/-17%比76+/-12%；P<；0.001)。结论：在接受限制性二尖瓣成形术的缺血性MR患者中，通过术前二尖瓣构型分析可以准确预测MR的持续性和3年无事件生存率。因此，PL角=45度(即PL限制较高)的患者应被认为是该手术的不良候选者，应考虑同期或替代手术。
Background - Ischemic mitral regurgitation (MR) often persists after restrictive mitral valve annuloplasty, in which case it is associated with worse clinical outcomes. The goal of the present study was to determine whether persistence of MR and/or clinical outcome could be predicted from preoperative analysis of mitral valve configuration.Methods and Results - In 51 consecutive patients undergoing restrictive annuloplasty for ischemic MR, posterior leaflet (PL) angle, anterior leaflet angle, coaptation distance, and tenting area were quantified by echocardiography before surgery (6 +/- 3 days), and MR severity was assessed before and early after surgery (9 +/- 4 days). Postoperatively, persistence of mild to moderate MR (vena contracta > 3 mm) was observed in 11 (22%) of the patients. The best predictor of postoperative persistence of MR was a PL angle >= 45 degrees (sensitivity 100%, specificity 97%, positive predictive value 92%, negative predictive value 100%). Patients with persistent MR had markedly lower 3-year event-free survival (26 +/- 20%) compared with those with nonpersistent MR (75 +/- 12%, P = 0.01). Preoperative presence of a PL angle >= 45 degrees also was associated with a markedly lower 3-year event-free survival (22 +/- 17% versus 76 +/- 12%; P < 0.001).Conclusions - In patients undergoing restrictive annuloplasty for ischemic MR, persistence of MR and 3-year event-free survival can accurately be predicted by preoperative analysis of mitral valve configuration. Patients with a PL angle >= 45 degrees (ie, with high PL restriction) should thus be considered poor candidates for this procedure, and concomitant or alternative procedures should be contemplated.