Isolated Mitral Valve Surgery: The Society of Thoracic Surgeons Adult Cardiac Surgery Database Analysis
Isolated Mitral Valve Surgery: The Society of Thoracic Surgeons Adult Cardiac Surgery Database Analysis
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DOI：
10.1016/j.athoracsur.2018.03.086
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发表时间：
2018-09-01
影响因子：
4.6
通讯作者：
Quinn, Rachael W.
中科院分区：
文献类型：
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作者：
Gammie, James S.;Chikwe, Joanna;Quinn, Rachael W.
背景对来自胸外科学会成人心脏手术数据库的数据进行分析，以确定北美二尖瓣手术患者特征和结局的趋势。确定了2011年7月至2016年9月进行的单独初次二尖瓣手术伴或不伴三尖瓣修复、外科房颤消融或房间隔缺损闭合的所有患者。一项亚组分析评估了退行性瓣叶脱垂（DLP）患者。在1，125家中心对87，214例患者进行了单独的初次二尖瓣手术，2011年（n = 14，442）至2016年（n = 17，907）增加了24%。最常见的病因是DLP（60.7%）; 4.3%有功能性二尖瓣返流。术前，47.3%的患者射血分数低于60%，34.2%的患者患有房颤。总体二尖瓣修复率为65.6%，从67.1%（2011年）降至63.2%（2016年; p < 0.0001）。修复率与病因相关（DLP，82.5%;风湿性，17.5%）。在29，970例二尖瓣置换术中，16.2%之前尝试过修复。修复技术包括人工瓣环成形术（94.3%）、瓣叶切除术（46.5%）和人工脐带植入术（22.7%）。生物瓣膜的植入频率增加（2011年，65.4%; 2016年，75.8%; p < 0.0001）。23.0%的患者进行了微创手术，15.7%的患者同时进行了三尖瓣修复术。未校正的手术死亡率为3.7%（置换）和1.1%（修复）。接受初次隔离二尖瓣手术的患者通常会出现心室功能障碍、房颤和心力衰竭。虽然目前的结果很好，但早期指南指导的转诊以及修复频率和质量的提高可能会进一步改善二尖瓣手术的结果。(C)2018胸外科医师协会
Background. Data from The Society of Thoracic Surgeons Adult Cardiac Surgery Database were analyzed to identify trends in patient characteristics and outcomes of mitral valve operations in North America.Methods. All patients with isolated primary mitral valve operations with or without tricuspid valve repair, surgical atrial fibrillation ablation, or atrial septal defect closure performed July 2011 to September 2016 were identified. A subgroup analysis assessed patients with degenerative leaflet prolapse (DLP).Results. Isolated primary mitral valve operations were performed on 87,214 patients at 1,125 centers, increasing by 24% between 2011 (n = 14,442) and 2016 (n = 17,907). The most common etiology was DLP (60.7%); 4.3% had functional mitral regurgitation. Preoperatively, 47.3% of patients had an ejection fraction less than 60% and 34.2% had atrial fibrillation. Overall mitral valve repair rate was 65.6%, declining from 67.1% (2011) to 63.2% (2016; p < 0.0001). Repair rates were related to etiology DLP, 82.5%; rheumatic, 17.5%). Of the 29,970 mitral valve replacements, 16.2% were preceded by an attempted repair. Repair techniques included prosthetic annuloplasty (94.3%), leaflet resection (46.5%), and artificial cord implantation (22.7%). Bioprosthetic valves were implanted with increasing frequency (2011, 65.4%; 2016, 75.8%; p < 0.0001). Less-invasive operations were performed in 23.0% and concomitant tricuspid valve repair in 15.7%. Unadjusted operative mortality was 3.7% (replacements) and 1.1% (repairs).Conclusions. Patients undergoing primary isolatedmitral valve operations commonly have ventricular dysfunction, atrial fibrillation, and heart failure. Although contemporary outcomes are excellent, earlier guideline-directed referral and increased frequency and quality of repair may further improve results of mitral valve operations. (C) 2018 by The Society of Thoracic Surgeons