人工腱索微创二尖瓣修复术:一项为期 6 年的单中心研究的启示

IF 1.3 4区 医学 Q3 CARDIAC & CARDIOVASCULAR SYSTEMS
V. Bui, Dang Nguyen, Alejandro Pizano, Heath Rutledge-Jukes, Chibuikem S. Iheagwaram, S. Bajaj, D. Van, Nam Hoai Nguyen, T. Theologou, A. Akbar, D. Vervoort, A. Harky, D. H. Nguyen
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Demographic variables, comorbidities, operative characteristics, surgical outcomes, and follow-up data on survival and mitral regurgitation (MR) grade were analyzed. The learning curve was assessed by comparing the number of procedures with operation time and aorta cross-clamp time. Primary endpoints included survival and freedom from recurrent MR at four years. Results. Ninety patients were identified, including 41 simple and 49 intermediate-to-complex repairs. The mean age was 50.5 ± 12.9 years. Both groups had similar preoperative characteristics. The perioperative and postoperative outcomes were favorable, with no cases requiring mitral valve replacement. The median follow-up time was 30.3 months (18.2–40.4), and there were two (2.2%) cardiac deaths, with one in each group. The Kaplan–Meier survival estimates for Groups 1 and 2 at 12 and 24 months were 97% vs. 100% and 97% vs. 96%, respectively (95% CI = 0.05–12.2, \n \n P\n =\n 0.850\n \n ), and estimates for freedom from recurrent MR were 97% vs. 92% and 97% vs. 88%, respectively (95% CI = 0.49–12.0, \n \n P\n =\n 0.260\n \n ). There was a negative association between the volume of operations and the duration of operation and aortic cross-clamp time, leading to shorter durations. Conclusion. Based on our single-center experience, MIMVR using artificial chordae via right mini-thoracotomy can be safely and effectively performed in resource-limited countries for patients with MR. 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引用次数: 0

摘要

目的。微创二尖瓣修复(MIMVR)已被证明是安全有效的,但技术上的困难、结果的变化和缺乏标准化的方案削弱了人工二尖瓣的实用性。本研究旨在分析经右小开胸人工索修复术的中期结果。方法。2016年4月至2022年4月在越南的一个中心对使用人工脊索进行MIMVR的连续患者进行了回顾性队列研究。根据先前验证的复杂性评分,将瓣膜修复分为两组:简单修复(组1)和中度至复杂修复(组2)。统计变量、合并症、手术特征、手术结果、生存和二尖瓣反流(MR)等级的随访数据进行分析。通过比较手术次数与手术时间和主动脉交叉夹夹时间来评估学习曲线。主要终点包括4年生存率和无复发MR。结果。确定了90例患者,包括41例简单修复和49例中到复杂修复。平均年龄50.5±12.9岁。两组术前特征相似。围手术期和术后结果良好,没有病例需要二尖瓣置换术。中位随访时间为30.3个月(18.2-40.4个月),有2例(2.2%)心源性死亡,每组1例。第1组和第2组在12个月和24个月时的Kaplan-Meier生存估计分别为97%对100%和97%对96% (95% CI = 0.05-12.2, P = 0.850),无复发MR的估计分别为97%对92%和97%对88% (95% CI = 0.49-12.0, P = 0.260)。手术量与手术时间和主动脉交叉夹夹时间呈负相关,导致手术时间缩短。结论。根据我们的单中心经验,在资源有限的国家,通过右小开胸使用人工索的MIMVR可以安全有效地治疗MR患者。这种方法已被证明适用于一系列MR复杂性,从简单到中等到复杂的MV修复,并且在中期免于MR复发方面显示出令人满意的结果。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
Minimally Invasive Mitral Valve Repair with Artificial Chordae: Insights from a 6-Year Single-Center Study
Purpose. Minimally invasive mitral valve repair (MIMVR) has been demonstrated to be safe and effective, but technical difficulty, outcome variation, and lack of standardized protocols undermine the utility of artificial chordae. This study aims to analyze the midterm outcomes of repair using artificial chordae through right minithoracotomy. Methods. A retrospective cohort study was conducted on consecutive patients who underwent MIMVR using artificial chordae at a single center in Vietnam between April 2016 and April 2022. Valve repairs were separated into two groups based on a previously validated complexity score: simple repair (Group 1) and intermediate-to-complex repair (Group 2). Demographic variables, comorbidities, operative characteristics, surgical outcomes, and follow-up data on survival and mitral regurgitation (MR) grade were analyzed. The learning curve was assessed by comparing the number of procedures with operation time and aorta cross-clamp time. Primary endpoints included survival and freedom from recurrent MR at four years. Results. Ninety patients were identified, including 41 simple and 49 intermediate-to-complex repairs. The mean age was 50.5 ± 12.9 years. Both groups had similar preoperative characteristics. The perioperative and postoperative outcomes were favorable, with no cases requiring mitral valve replacement. The median follow-up time was 30.3 months (18.2–40.4), and there were two (2.2%) cardiac deaths, with one in each group. The Kaplan–Meier survival estimates for Groups 1 and 2 at 12 and 24 months were 97% vs. 100% and 97% vs. 96%, respectively (95% CI = 0.05–12.2, P = 0.850 ), and estimates for freedom from recurrent MR were 97% vs. 92% and 97% vs. 88%, respectively (95% CI = 0.49–12.0, P = 0.260 ). There was a negative association between the volume of operations and the duration of operation and aortic cross-clamp time, leading to shorter durations. Conclusion. Based on our single-center experience, MIMVR using artificial chordae via right mini-thoracotomy can be safely and effectively performed in resource-limited countries for patients with MR. This approach has been shown to be applicable for a range of MR complexities, from simple to intermediate-to-complex MV repairs, and has demonstrated promising results in terms of midterm freedom from MR recurrence.
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来源期刊
CiteScore
2.90
自引率
12.50%
发文量
976
审稿时长
3-8 weeks
期刊介绍: Journal of Cardiac Surgery (JCS) is a peer-reviewed journal devoted to contemporary surgical treatment of cardiac disease. Renown for its detailed "how to" methods, JCS''s well-illustrated, concise technical articles, critical reviews and commentaries are highly valued by dedicated readers worldwide. With Editor-in-Chief Harold Lazar, MD and an internationally prominent editorial board, JCS continues its 20-year history as an important professional resource. Editorial coverage includes biologic support, mechanical cardiac assist and/or replacement and surgical techniques, and features current material on topics such as OPCAB surgery, stented and stentless valves, endovascular stent placement, atrial fibrillation, transplantation, percutaneous valve repair/replacement, left ventricular restoration surgery, immunobiology, and bridges to transplant and recovery. In addition, special sections (Images in Cardiac Surgery, Cardiac Regeneration) and historical reviews stimulate reader interest. The journal also routinely publishes proceedings of important international symposia in a timely manner.
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