Elevated gradient after mitral valve repair: The effect of surgical technique and relevance of postoperative atrial fibrillation
Elevated gradient after mitral valve repair: The effect of surgical technique and relevance of postoperative atrial fibrillation
复制标题
二尖瓣修复术后梯度升高：手术技术的效果与术后房颤的相关性
DOI：
10.1016/j.jtcvs.2018.07.107
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发表时间：
2019-03-01
影响因子：
6
通讯作者：
Zhang, Wei
中科院分区：
文献类型：
--
作者：
Ma, Wenrui;Shi, Wei;Zhang, Wei
目的：探讨二尖瓣修复手术技术对术后房颤传导梯度（PTMG）的影响以及PTMG与术后房颤（AF）的关系。方法：在这项回顾性研究中，390例因退行性二尖瓣反流而接受二尖瓣修复的无房颤患者。出院前经胸超声心动图测量PTMG。随访时，记录并调查手术后6个月内（早期AF）和6个月内（晚期AF） AF的发生情况，以及临床和超声心动图资料。结果：住院死亡率为0，出院前平均梯度为3.1 +/- 1.2 mm Hg。更高PTMG的风险包括腭裂闭合、边缘对边缘技术、全环环成形术和较小的指标性假体尺寸（P < 0.05）。中位随访46个月后，73.1%的患者维持了稳定的窦性心律，22.7%的患者发生了早期房颤。晚期房颤32例（8.5%），与PTMG有显著相关性（优势比3.93;P = 0.004）。最小P值法确定>= 4.5 mm Hg的平均梯度为预测晚期AF的最佳阈值(chi(2) = 40.704；P < 0.001)。结论：因退行性二尖瓣功能不全而接受二尖瓣修复的患者可能受益于对现有小叶修复和环成形术的改进，以达到较低的PTMG水平，这与中期随访中晚期房颤发生率降低有关。
Objectives: We sought to investigate the effect of surgical technique in mitral valve repair on postoperative transmitral gradient (PTMG) and the relationship between PTMG and postoperative atrial fibrillation (AF).Methods: In this retrospective study, 390 patients who underwent mitral valve repair for degenerative mitral regurgitation without AF were included. PTMG was measured using transthoracic echocardiography before patient discharge. At follow-up, occurrences of AF within 6 months of surgery (early AF) and 6 months after surgery (late AF), as well as clinical and echocardiographic data were documented and investigated.Results: The in-hospital mortality was 0, and the mean gradient was 3.1 +/- 1.2 mm Hg before patient discharge. The risks for higher PTMG included cleft closure, edge-to-edge technique, full ring annuloplasty, and smaller indexed prosthetic size (P < .05 for all). After a median follow-up of 46 months, stable sinus rhythm was maintained in 73.1% of the overall cohort and early AF occurred in 22.7% of patients. A total of 32 patients (8.5%) had late AF, which was significantly associated with PTMG (odds ratio, 3.93; P = .004). The minimum P value approach identified a mean gradient of >= 4.5 mm Hg as the best threshold for predicting late AF (chi(2) = 40.704; P < .001).Conclusions: Patients who undergo mitral valve repair for degenerative mitral insufficiency might benefit from modification of the existing leaflet repair and annuloplasty techniques to achieve a lower PTMG level, which is associated with a decreased incidence of late AF during midterm follow-up.