The GeoForm annuloplasty ring for the surgical treatment of functional mitral regurgitation in advanced dilated cardiomyopathy
The GeoForm annuloplasty ring for the surgical treatment of functional mitral regurgitation in advanced dilated cardiomyopathy
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DOI：
10.1016/j.ejcts.2010.11.048
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发表时间：
2011-08-01
影响因子：
3.4
通讯作者：
Alfieri, Ottavio
中科院分区：
文献类型：
--
作者：
De Bonis, Michele;Taramasso, Maurizio;Alfieri, Ottavio
目的：评估三维 (3D) 形状的 GeoForm 环治疗功能性二尖瓣反流 (FMR) 的效果。方法：74 名患有严重 FMR 和收缩功能障碍的患者接受了 GeoForm 环植入术。 46 名患者 (62%) 属于纽约心脏协会 (NYHA) III-IV 级。同期手术包括冠状动脉旁路移植术 (CABG)（33 名患者）、三尖瓣修复术（23 名患者）、心房颤动消融术（20 名患者）、主动脉瓣置换术（8 名患者）和左心室 (LV) 重建（5 名患者）。结果：医院死亡率为 9%。另有三名患者出院后死亡。 3.5 年总生存率为 81.1 +/- 6.6%。 67 名医院幸存者接受了临床和超声心动图随访，平均随访时间为 1.9 +/- 1.25 年（中位时间 1.7 年）。 83% 的患者 (56/67) 不存在 MR 或轻度 MR，7% (5/67) 患者为中度 MR，其余 9% (6/67) 为中度至重度 MR。 3.5 年时，总体无 MR >= 3+ 的比例为 85.1 +/- 8%，无 MR >= 2+ 的比例为 75.1 +/- 8.6%。统计分析发现，术前不对称栓系以及普遍存在的后叶运动受限是 MR >= 2+ 复发的唯一预测因素（风险比 (HR) 6.1，p = 0.005）。符合本具体分析条件的 54 名患者中，有 31 名患者出现了反向左室重构（31/54，57%）：左室舒张末期和收缩末期容积指数均显着下降（均 p = 0.0001），肺动脉收缩压 (SPAP) (p = 0.006) 也显着下降。射血分数从 33 +/- 8% 增加到 43 +/- 8% (p < 0.0001)。对八名患者组成的亚组进行了负荷超声心动图检查。静息时的平均二尖瓣面积为 2.2 +/- 0.3 cm(2)，在应激过程中没有变化。所有患者在运动期间心输出量均显着增加。尽管静息时的平均和峰值二尖瓣梯度分别为 3.3 +/- 1.3 和 8.1 +/- 2.2 mmHg，压力下分别为 6.6 +/- 2.5 和 14.8 +/- 3.9 mmHg（均 p < 0.003），但 SPAP 的增加并不具有统计学意义（28 +/- 3.0 与 31 +/- 7.5 mmHg，p = 0.17），揭示了心脏对运动的适应性。结论：GeoForm 环可有效缓解大多数扩张型心肌病患者的 FMR。在后叶普遍存在运动受限的情况下，更可能发生明显的 MR 复发。运动期间未检测到临床相关的二尖瓣狭窄。 (C) 2010 年欧洲心胸外科协会。由 Elsevier B.V 出版。保留所有权利。
Objective: To assess the results of the three-dimensional (3D)-shaped GeoForm ring for the treatment of functional mitral regurgitation (FMR). Methods: Seventy-four patients with severe FMR and systolic dysfunction underwent GeoForm ring implantation. Forty-six patients (62%) were in the New York Heart Association (NYHA) class III-IV. Concomitant procedures were coronary artery bypass grafting (CABG) (33 patients (pts)), tricuspid repair (23 pts), atrial fibrillation ablation (20 pts), aortic valve replacement (eight pts) and left-ventricular (LV) reconstruction (five pts). Results: Hospital mortality was 9%. Three more patients died after hospital discharge. Overall survival was 81.1 +/- 6.6% at 3.5 years. The 67 hospital survivors underwent clinical and echocardiographic follow-up at a mean follow-up period of 1.9 +/- 1.25 years (median 1.7 years). MR was absent or mild in 83% of the patients (56/67), moderate in 7% (5/67), and moderate to severe in the remaining 9% (6/67). At 3.5 years, overall freedom from MR >= 3+ was 85.1 +/- 8% and freedom from MR >= 2+ was 75.1 +/- 8.6%. Statistical analysis identified preoperative asymmetric tethering with prevalent restricted motion of the posterior leaflet as the only predictor of recurrence of MR >= 2+ (hazard ratio (HR) 6.1, p = 0.005). Reverse LV remodeling was demonstrated in 31 of the 54 patients eligible for this specific analysis (31/54, 57%): Both LV end-diastolic and end-systolic volumes indexed significantly decreased (both p = 0.0001) as well as systolic pulmonary artery pressure (SPAP) (p = 0.006). Ejection fraction increased from 33 +/- 8% to 43 +/- 8% (p < 0.0001). Stress echocardiography was performed in a subgroup of eight patients. Mean mitral area at rest was 2.2 +/- 0.3 cm(2) and did not change during stress. Cardiac output significantly increased in all patients during exercise. Although mean and peak transmitral gradients were 3.3 +/- 1.3 and 8.1 +/- 2.2 mmHg at rest and 6.6 +/- 2.5 and 14.8 +/- 3.9 mmHg under stress, respectively (both p < 0.003), the increase in SPAP was not statistically significant (28 +/- 3.0 vs 31 +/- 7.5 mmHg, p = 0.17), revealing a preserved cardiac adaptation to exercise. Conclusions: The GeoForm ring is effective in relieving FMR in most of the patients with dilated cardiomyopathy. In presence of prevalent restricted motion of the posterior leaflet, recurrence of significant MR is more likely to occur. Clinically relevant mitral stenosis was not detected during exercise. (C) 2010 European Association for Cardio-Thoracic Surgery. Published by Elsevier B. V. All rights reserved.