经皮球囊二尖瓣成形术成功后的长期随访。

Q3 Medicine
Journal of Heart Valve Disease Pub Date : 2017-11-01
Inês Rodrigues, Luísa Branco, Lino Patrício, Luís Bernardes, João Abreu, Duarte Cacela, Ana Galrinho, Rui Ferreira
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引用次数: 0

摘要

背景:经皮球囊二尖瓣成形术(PMV)是合适患者风湿性二尖瓣狭窄治疗的基石。先前的研究报道了低技术失败率和很少的主要并发症,在成功的PMV后具有良好的长期效果。该研究的目的是评估在单一三级中心进行PMV后患者的长期预后。方法:1991年至2010年间,共有213例患者在作者中心连续接受了PMV。确定手术成功的标准是术后二尖瓣面积≥1.5 cm2,二尖瓣返流小于III级,无院内主要心脑血管事件。在随访期间评估的主要终点是心血管死亡的发生和二尖瓣再干预(经皮或手术)的需要。生成Kaplan-Meier曲线来确定事件发生率,并使用Cox回归分析确定PMV成功患者主要心脏事件的预测因素。结果:共有190例患者(89%)成功进行了PMV;其中88%的人目前正在作者中心接受随访。在平均11.2±7.3年的随访期间,25.1%的患者至少发生了一次主要的心脏不良事件(6.6%的全因死亡,6.6%的重复PMV, 21%的患者需要二尖瓣手术)。20年累积无事件生存率为54.7±6.3%。在单因素分析中,超声心动图评分[危险比(HR) = 1.25 (1.00-1.70), p]结论:在PMV成功后的20年内,相当大比例的患者仍然无事件发生,这证实了PMV的晚期疗效。在目前的患者队列中,PMV前的超声心动图评分是长期事件的唯一独立预测因子。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
Long-Term Follow Up After Successful Percutaneous Balloon Mitral Valvuloplasty.

Background: Percutaneous balloon mitral valvuloplasty (PMV) is the cornerstone of rheumatic mitral stenosis treatment in suitable patients. Previous studies have reported low rates of technical failure and few major complications, with good long-term results after successful PMV. The study aim was to assess the very long-term outcome in patients after PMV performed at a single tertiary center.

Methods: Between 1991 and 2010, a total of 213 consecutive patients underwent PMV at the authors' center. The criteria used to define successful procedure were post-procedural mitral valve area ≥1.5 cm2 and mitral regurgitation less than grade III, without in-hospital major cardiac or cerebrovascular events. The primary endpoint evaluated during the follow up period was the occurrence of cardiovascular death and need for mitral reintervention (percutaneous or surgical). Kaplan-Meier curves were generated to determine event rates, and predictors of major cardiac events in patients with successful PMV were determined using Cox regression analysis.

Results: A total of 190 patients (89%) underwent a successful PMV; 88% of these are currently being followed up at the authors' center. During a mean follow up of 11.2 ± 7.3 years, at least one major adverse cardiac event occurred in 25.1% of patients (6.6% all-cause death, 6.6% repeated PMV, 21% required mitral valve surgery). Cumulative event-free survival at 20 years was 54.7 ± 6.3%. On univariate analysis, the echocardiographic score [hazard ratio (HR) = 1.25 (1.00-1.70), p <0.05], left atrial diameter [HR = 1.06 (1.01-1.11), p <0.05] and mean mitral valve gradient soon after the procedure [HR = 1.25 (1.02-1.55), p <0.05] were predictors of events. On multivariate analysis, the echocardiographic mitral valve score before PMV was the only independent predictor of primary outcome [HR=1.75 (1.16-2.64), p<0.01].

Conclusions: Up to 20 years after successful PMV, a sizeable proportion of patients remained event-free, which confirmed the late efficacy of PMV. Among the present patient cohort, echocardiographic score before PMV was the only independent predictor of long term events.

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来源期刊
Journal of Heart Valve Disease
Journal of Heart Valve Disease 医学-心血管系统
CiteScore
1.00
自引率
0.00%
发文量
0
审稿时长
4-8 weeks
期刊介绍: The Journal of Heart Valve Disease (ISSN 0966-8519) is the official journal of The Society for Heart Valve Disease. It is indexed/abstracted by Index Medicus, Medline, Medlar, PubMed, Science Citation Index, Scisearch, Research Alert, Biomedical Products, Current Contents/Clinical Medicine. It is issued bi-monthly in one indexed volume by ICR Publishers Ltd., Crispin House, 12A South Approach, Moor Park, Northwood HA6 2ET, United Kingdom. This paper meets the requirements of ANSI standard Z39.48-1992 (Permanence of Paper).
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