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IF 1.3 4区医学 Q3 CARDIAC & CARDIOVASCULAR SYSTEMS

Journal of Cardiac Surgery Pub Date : 2025-01-07 DOI:10.1155/jocs/6839315

Brittany A. Zwischenberger, Jeffrey G. Gaca, Keith Carr, Caitlin Cosme, Muath Bishawi, Andrew Wang, Donald D. Glower

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引用次数: 0

摘要

背景：二尖瓣边缘到边缘技术（Alfieri针）修复已经有20多年的历史了，但关于二尖瓣狭窄的后期耐久性和潜在风险的报道很少，仍然存在争议。本研究的主要目的是描述Alfieri针在二尖瓣修复中的特点和后期耐久性。方法：从2004年到2019年，我们回顾了前瞻性维护的机构数据库中1175例接受修复的退行性二尖瓣反流（MR）患者的数据。同时接受手术的患者也包括在内。对使用和不使用Alfieri针的患者进行倾向评分匹配，以比较临床（生存和再手术）和超声心动图（中度或重度MR[“中度或更多MR”]，重度MR和二尖瓣狭窄）长达10年的结果。结果：1175例患者接受了二尖瓣修复；55.1% （n = 648）采用Alfieri针。中位随访时间为4.7年（2.0年，8.2年）。使用和不使用Alfieri针的匹配患者在中度或以上MR（24%±5% vs. 17%±4%,p = 0.2）、重度MR（5%±2% vs. 4%±2%,p = 0.3）和二尖瓣再手术（9%±3% vs. 2%±1%,p = 0.06）的累积发生率（CI）相似，生存率无差异（84%±3% vs. 81%±3%,p = 0.2）。Alfieri缝合导致二尖瓣梯度略高（3.9%±1.5 mmHg vs. 3.6%±1.6 mmHg, p = 0.0003）。二尖瓣狭窄10年时的CI可以忽略不计（1例有Alfieri针，2例无Alfieri针）。结论：在选定的退行性二尖瓣返流患者中，Alfieri缝线修复二尖瓣是持久的，其后期效果与其他修复技术相当。Alfieri针可能是一个有用的工具，在选择复杂的二尖瓣病理与最小的发生率增加二尖瓣狭窄。需要进一步的调查来确定使用Alfieri针的最佳适应症。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

Alfieri Stitch (Edge To Edge) in Degenerative Mitral Valve Repair: Characteristics and Late Durability in 648 Patients

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Alfieri Stitch (Edge To Edge) in Degenerative Mitral Valve Repair: Characteristics and Late Durability in 648 Patients

Background: Mitral valve repair with the edge-to-edge technique (Alfieri stitch) has been described for over 20 years, yet little is published on late durability and potential risk of mitral stenosis remains controversial. The primary objective of this study is to describe characteristics and late durability of Alfieri stitch in mitral valve repair.

Methods: From 2004 to 2019, we reviewed data from our prospectively maintained institutional database on 1175 consecutive patients with degenerative mitral regurgitation (MR) who underwent repair. Patients undergoing concomitant operations were included. Propensity score matching was performed on patients with and without Alfieri stitch to compare clinical (survival and reoperation) and echocardiographic (moderate or severe MR [“moderate or more MR”], severe MR, and mitral stenosis) outcomes up to 10 years.

Results: Overall, 1175 patients underwent mitral valve repair; 55.1% (n = 648) received the Alfieri stitch. The median follow-up was 4.7 (2.0, 8.2) years. Matched patients with and without Alfieri stitch had similar cumulative incidence (CI) of moderate or more MR (24% ± 5% vs. 17% ± 4%, p = 0.2, respectively), severe MR (5% ± 2% vs. 4% ± 2%, p = 0.3), and mitral reoperation (9% ± 3% vs. 2% ± 1%, p = 0.06) with no difference in survival (84% ± 3% vs. 81% ± 3%, p = 0.2). The Alfieri stitch resulted in a slightly higher mean mitral valve gradient (3.9% ± 1.5 mmHg vs. 3.6% ± 1.6 mmHg, p = 0.0003). The CI of mitral stenosis at 10 years was negligible (one patient with Alfieri stitch and two patients without Alfieri stitch).

Conclusions: In selected patients with degenerative mitral regurgitation, mitral valve repair with Alfieri stitch is durable with late outcomes comparable with other repair techniques. The Alfieri stitch may be a useful tool in selecting complex mitral pathology with minimal increased incidence of mitral stenosis. Further investigation is needed to delineate best indications for the use of Alfieri stitch.

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来源期刊

Journal of Cardiac Surgery 医学-外科

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.