Early and Late Results after Surgical Mitral Valve Repair: A High-Volume Center Experience.

IF 1.3 4区 医学 Q3 CARDIAC & CARDIOVASCULAR SYSTEMS
Julia Götte, Armin Zittermann, Marcus-Andre Deutsch, Rene Schramm, Sabine Bleiziffer, Andre Renner, Jan F Gummert
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引用次数: 0

Abstract

Background:  Surgical mitral valve repair is the gold standard treatment of severe primary mitral regurgitation (MR). In the light of rapidly evolving percutaneous technologies, current surgical outcome data are essential to support heart-team-based decision-making.

Methods:  This retrospective, high-volume, single-center study analyzed in 1779 patients with primary MR early morbidity and mortality, postoperative valve function, and long-term survival after mitral valve (MV) repair. Surgeries were performed between 2009 and 2022. Surgical approaches included full sternotomy (FS) and right-sided minithoracotomy (minimally invasive cardiac [MIC] surgery).

Results:  Of the surgeries (mean age: 59.9 [standard deviation:11.4] years; 71.5% males), 85.6% (n = 1,527) were minithoracotomies. Concomitant procedures were performed in 849 patients (47.7%), including tricuspid valve and/or atrial septal defect repair, cryoablation, and atrial appendage closure. The majority of patients did not need erythrocyte concentrates. Mediastinitis and rethoracotomy for bleeding rates were 0.1 and 4.3%, respectively. Reoperation before discharge for failed repair was necessary in 12 patients (0.7%). Freedom from more than moderate MR was > 99%. Thirty-day mortality was 0.2% and did not differ significantly between groups (p = 0.37). Median follow-up was 48.2 months with a completeness of 95.9%. Long-term survival was similar between groups (p = 0.21). In the FS and MIC groups, 1-, 5-, and 10-year survival rates were 98.8 and 98.8%, 92.9 and 94.4%, and 87.4 and 83.1%, respectively.

Conclusion:  MV surgery, both minimally invasive and via sternotomy, is associated with high repair rates, excellent perioperative outcomes, and long-term survival. Data underscore the effectiveness of surgical repair in managing MR, even in the era of advancing interventional techniques.

手术二尖瓣修复术后的早期和晚期效果:大容量中心的经验
背景:手术二尖瓣修复是治疗严重原发性二尖瓣反流(MR)的金标准。鉴于经皮技术的快速发展,当前的手术结果数据对于支持心脏团队的决策至关重要:这项回顾性、高容量、单中心研究分析了 1779 例原发性二尖瓣反流患者的早期发病率和死亡率、术后瓣膜功能以及二尖瓣修复术后的长期存活率。手术时间为 2009 年至 2022 年。手术方法包括全胸骨切开术(FS)和右侧小胸骨切开术(MIC):在所有手术中(平均年龄:59.9(SD:11.4)岁;71.5%为男性),85.6%(n=1527)为迷你胸廓切开术。849名患者(47.7%)接受了伴随手术,包括三尖瓣和/或房间隔缺损修复术、低温消融术和心房阑尾闭合术。大多数患者不需要浓缩红细胞。纵隔炎和因出血而再次进行胸廓切开术的比例分别为0.1%和4.3%。12名患者(0.7%)在出院前因修复失败而需要再次手术。中度以上 MR 的治愈率大于 99%。30天死亡率为0.2%,组间差异不大(P=0.37)。中位随访时间为 48.2 个月,随访完成率为 95.9%。各组的长期存活率相似(P=0.21)。FS组和MIC组的1年、5年和10年生存率分别为98.8%和98.8%、92.9%和94.4%、87.4%和83.1%:二尖瓣手术,无论是微创手术还是胸骨切开术,都具有较高的修复率、良好的围手术期效果和长期生存率。数据强调了手术修复在治疗 MR 方面的有效性,即使在介入技术不断发展的时代也是如此。
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来源期刊
CiteScore
3.40
自引率
6.70%
发文量
365
审稿时长
3 months
期刊介绍: The Thoracic and Cardiovascular Surgeon publishes articles of the highest standard from internationally recognized thoracic and cardiovascular surgeons, cardiologists, anesthesiologists, physiologists, and pathologists. This journal is an essential resource for anyone working in this field. Original articles, short communications, reviews and important meeting announcements keep you abreast of key clinical advances, as well as providing the theoretical background of cardiovascular and thoracic surgery. Case reports are published in our Open Access companion journal The Thoracic and Cardiovascular Surgeon Reports.
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