{"title":"外科治疗严重二尖瓣反流:病因很重要。","authors":"Yi-Lin Tsai, Ching-Wei Lee, Wei-Ming Huang, Hao-Min Cheng, Wen-Chung Yu, Chen-Huan Chen, Shih-Hsien Sung","doi":"10.1097/JCMA.0000000000000977","DOIUrl":null,"url":null,"abstract":"Background: While surgery has been the standard treatment for patients with severe primary mitral regurgitation (PMR), the role of surgery for severe secondary mitral regurgitation (SMR) remained debated. We therefore investigated the prognostic differences of surgery for patients with either severe PMR or SMR. Methods: Subjects hospitalized for heart failure were enrolled from 2002 to 2012. The severity of MR was assessed by continuity equation, and an effective regurgitant orifice area of ≥40 mm2 was defined as severe. Long-term survival was then identified by the National Death Registry. Results: A total of 1143 subjects (66.4 ± 16.6 years, 65% men, and 59.7% PMR) with severe MR were analyzed. Compared with PMR, patients with SMR were older, had more comorbidities, greater left atrial and ventricular diameter, and less left ventricular ejection fraction (all p < 0.05). While 47.8% of PMR patients received mitral valve surgery, only 6.9% of SMR patients did. Surgical intervention crudely was associated with 54% reduction of all-cause mortality in PMR (hazard ratio, 0.46; 95% confident interval, 0.32-0.67), and 48% in the subpopulation with SMR (0.52, 0.30-0.91). Propensity score matching analysis demonstrated the survival benefits of mitral valve surgery was observed in patients with PMR (log rank p = 0.024), but not with SMR. Among the unoperated subjects, age, renal function, and right ventricular systolic pressure were common risk factors of mortality, regardless of MR etiology. Conclusion: Mitral valve surgery for patients with heart failure and severe MR was associated with better survival in patients with PMR, but not in those with SMR.","PeriodicalId":17251,"journal":{"name":"Journal of the Chinese Medical Association","volume":null,"pages":null},"PeriodicalIF":1.9000,"publicationDate":"2023-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":"{\"title\":\"Surgery for severe mitral regurgitation: The etiology matters.\",\"authors\":\"Yi-Lin Tsai, Ching-Wei Lee, Wei-Ming Huang, Hao-Min Cheng, Wen-Chung Yu, Chen-Huan Chen, Shih-Hsien Sung\",\"doi\":\"10.1097/JCMA.0000000000000977\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"Background: While surgery has been the standard treatment for patients with severe primary mitral regurgitation (PMR), the role of surgery for severe secondary mitral regurgitation (SMR) remained debated. We therefore investigated the prognostic differences of surgery for patients with either severe PMR or SMR. Methods: Subjects hospitalized for heart failure were enrolled from 2002 to 2012. The severity of MR was assessed by continuity equation, and an effective regurgitant orifice area of ≥40 mm2 was defined as severe. Long-term survival was then identified by the National Death Registry. Results: A total of 1143 subjects (66.4 ± 16.6 years, 65% men, and 59.7% PMR) with severe MR were analyzed. Compared with PMR, patients with SMR were older, had more comorbidities, greater left atrial and ventricular diameter, and less left ventricular ejection fraction (all p < 0.05). While 47.8% of PMR patients received mitral valve surgery, only 6.9% of SMR patients did. Surgical intervention crudely was associated with 54% reduction of all-cause mortality in PMR (hazard ratio, 0.46; 95% confident interval, 0.32-0.67), and 48% in the subpopulation with SMR (0.52, 0.30-0.91). Propensity score matching analysis demonstrated the survival benefits of mitral valve surgery was observed in patients with PMR (log rank p = 0.024), but not with SMR. Among the unoperated subjects, age, renal function, and right ventricular systolic pressure were common risk factors of mortality, regardless of MR etiology. Conclusion: Mitral valve surgery for patients with heart failure and severe MR was associated with better survival in patients with PMR, but not in those with SMR.\",\"PeriodicalId\":17251,\"journal\":{\"name\":\"Journal of the Chinese Medical Association\",\"volume\":null,\"pages\":null},\"PeriodicalIF\":1.9000,\"publicationDate\":\"2023-10-01\",\"publicationTypes\":\"Journal Article\",\"fieldsOfStudy\":null,\"isOpenAccess\":false,\"openAccessPdf\":\"\",\"citationCount\":\"0\",\"resultStr\":null,\"platform\":\"Semanticscholar\",\"paperid\":null,\"PeriodicalName\":\"Journal of the Chinese Medical Association\",\"FirstCategoryId\":\"3\",\"ListUrlMain\":\"https://doi.org/10.1097/JCMA.0000000000000977\",\"RegionNum\":4,\"RegionCategory\":\"医学\",\"ArticlePicture\":[],\"TitleCN\":null,\"AbstractTextCN\":null,\"PMCID\":null,\"EPubDate\":\"2023/8/10 0:00:00\",\"PubModel\":\"Epub\",\"JCR\":\"Q2\",\"JCRName\":\"MEDICINE, GENERAL & INTERNAL\",\"Score\":null,\"Total\":0}","platform":"Semanticscholar","paperid":null,"PeriodicalName":"Journal of the Chinese Medical Association","FirstCategoryId":"3","ListUrlMain":"https://doi.org/10.1097/JCMA.0000000000000977","RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"2023/8/10 0:00:00","PubModel":"Epub","JCR":"Q2","JCRName":"MEDICINE, GENERAL & INTERNAL","Score":null,"Total":0}
引用次数: 0
摘要
背景:虽然手术一直是严重原发性二尖瓣返流(PMR)患者的标准治疗方法,但手术在严重继发性二尖瓣反流(SMR)中的作用仍存在争议。因此,我们调查了严重PMR或SMR患者手术的预后差异。方法:2002年至2012年因心力衰竭住院的受试者。通过连续性方程评估MR的严重程度,有效反流口面积≥40 mm 2定义为严重。国家死亡登记处确定了长期存活率。结果:共有1143名受试者(66.4 ± 16.6岁,65%为男性,59.7%为PMR)。与PMR相比,SMR患者年龄较大,合并症较多,左心房和心室直径较大,左心室射血分数较低(均p<0.05)。虽然47.8%的PMR患者接受了二尖瓣手术,但只有6.9%的SMR患者接受。手术干预可使PMR患者的全因死亡率降低54%(危险比为0.46;95%置信区间为0.32-0.67),SMR患者的死亡率降低48%(0.52,0.30-0.91)。倾向评分匹配分析表明,在PMR患者中观察到二尖瓣手术的生存益处(log秩p=0.024),但在SMR患者中没有观察到。在未手术的受试者中,年龄、肾功能和右心室收缩压是常见的死亡危险因素,无论MR病因如何。结论:心力衰竭和严重MR患者的二尖瓣手术与PMR患者更好的生存率相关,但与SMR患者无关。
Surgery for severe mitral regurgitation: The etiology matters.
Background: While surgery has been the standard treatment for patients with severe primary mitral regurgitation (PMR), the role of surgery for severe secondary mitral regurgitation (SMR) remained debated. We therefore investigated the prognostic differences of surgery for patients with either severe PMR or SMR. Methods: Subjects hospitalized for heart failure were enrolled from 2002 to 2012. The severity of MR was assessed by continuity equation, and an effective regurgitant orifice area of ≥40 mm2 was defined as severe. Long-term survival was then identified by the National Death Registry. Results: A total of 1143 subjects (66.4 ± 16.6 years, 65% men, and 59.7% PMR) with severe MR were analyzed. Compared with PMR, patients with SMR were older, had more comorbidities, greater left atrial and ventricular diameter, and less left ventricular ejection fraction (all p < 0.05). While 47.8% of PMR patients received mitral valve surgery, only 6.9% of SMR patients did. Surgical intervention crudely was associated with 54% reduction of all-cause mortality in PMR (hazard ratio, 0.46; 95% confident interval, 0.32-0.67), and 48% in the subpopulation with SMR (0.52, 0.30-0.91). Propensity score matching analysis demonstrated the survival benefits of mitral valve surgery was observed in patients with PMR (log rank p = 0.024), but not with SMR. Among the unoperated subjects, age, renal function, and right ventricular systolic pressure were common risk factors of mortality, regardless of MR etiology. Conclusion: Mitral valve surgery for patients with heart failure and severe MR was associated with better survival in patients with PMR, but not in those with SMR.
期刊介绍:
Journal of the Chinese Medical Association, previously known as the Chinese Medical Journal (Taipei), has a long history of publishing scientific papers and has continuously made substantial contribution in the understanding and progress of a broad range of biomedical sciences. It is published monthly by Wolters Kluwer Health and indexed in Science Citation Index Expanded (SCIE), MEDLINE®, Index Medicus, EMBASE, CAB Abstracts, Sociedad Iberoamericana de Informacion Cientifica (SIIC) Data Bases, ScienceDirect, Scopus and Global Health.
JCMA is the official and open access journal of the Chinese Medical Association, Taipei, Taiwan, Republic of China and is an international forum for scholarly reports in medicine, surgery, dentistry and basic research in biomedical science. As a vehicle of communication and education among physicians and scientists, the journal is open to the use of diverse methodological approaches. Reports of professional practice will need to demonstrate academic robustness and scientific rigor. Outstanding scholars are invited to give their update reviews on the perspectives of the evidence-based science in the related research field. Article types accepted include review articles, original articles, case reports, brief communications and letters to the editor