Abstract

 

OBJECTIVES

The aim of this study was to identify predictors of periprocedural success and safety in minimally invasive mitral valve surgery and to determine the impact of pathology localization and repair technique on reoperation-free survival.

METHODS

We isolated 686 patients (mean age 60.5, standard deviation 12.3 years, 69.4% male) who underwent surgery for mitral valve prolapse between 2002 and 2020 in a single institution. Patients with concomitant disease, redo or mitral pathology other than degenerative mitral disease were excluded from the analysis. Periprocedural safety was defined as: freedom from perioperative death, myocardial infarction, stroke, use of extracorporeal membrane oxygenation or reoperation for bleeding. Operative success was defined as: successful primary mitral repair without conversion to replacement or to larger thoracic incisions, without residual mitral regurgitation > mild at discharge or reoperation within 30 days. Predictors for perioperative success and safety were identified using univariable and multivariable analyses. The impact of prolapse localization and repair technique on reoperation-free survival was assessed by Cox regression.

RESULTS

The mitral repair rate and the need for concomitant tricuspid repair were 94.6% and 16.5%, respectively. Perioperative mortality occurred in 5 patients (0.7%). The criteria for perioperative safety and success were met in 646/686 (94.2%) and 648/686 (94.5%) patients, respectively. The absence of tricuspid disease requiring repair was the only independent predictor of safety in this cohort [hazard ratio (HR) 0.460 (0.225–0.941), P = 0.033]. The only independent predictor of operative success was the use of chordal replacement [0.27 (0.09–0.83), P = 0.022]. Reoperation-free survival was 98.5%, 94.5% and 86.9% at 1, 5 and 10 years, respectively. Posterior leaflet pathology demonstrated a higher reoperation-free survival as compared to other localizations (log-rank P = 0.002). The localization of leaflet pathology but not the repair method was an independent predictor for reoperation-free survival (HR 1.455, 95% confidence interval 1.098–1.930; P = 0.009).

CONCLUSIONS

In minimally invasive mitral surgery for degenerative disease, chordal replacement yields higher rates of periprocedural success than leaflet resection. Posterior leaflet pathology is an independent predictor of reoperation-free survival.

中文翻译：

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退行性二尖瓣疾病微创手术安全性和成功率的预测因素

摘要

 

目标

本研究的目的是确定微创二尖瓣手术围手术期成功和安全的预测因素，并确定病理定位和修复技术对无再手术生存率的影响。

方法

我们隔离了 686 名患者（平均年龄 60.5 岁，标准差 12.3 岁，69.4% 男性），他们在 2002 年至 2020 年期间在一个机构中接受了二尖瓣脱垂手术。除退行性二尖瓣疾病外，伴有疾病、重做或二尖瓣病变的患者被排除在分析之外。围手术期安全性定义为：无围手术期死亡、心肌梗死、中风、使用体外膜肺氧合或再次手术治疗出血。手术成功的定义为：二尖瓣一期修复成功，没有转换为置换或更大的胸部切口，无残余二尖瓣反流> 出院或 30 天内再次手术时轻度。使用单变量和多变量分析确定了围手术期成功和安全的预测因素。

结果

二尖瓣修复率和同时进行三尖瓣修复的需要分别为 94.6% 和 16.5%。5 例患者（0.7%）发生围手术期死亡率。分别有 646/686 (94.2%) 和 648/686 (94.5%) 名患者符合围手术期安全性和成功标准。没有需要修复的三尖瓣疾病是该队列中唯一的安全性独立预测因子 [风险比 (HR) 0.460 (0.225–0.941)，P  = 0.033]。手术成功的唯一独立预测因素是使用腱索置换 [0.27 (0.09–0.83), P  = 0.022]。1、5 和 10 年的无再手术生存率分别为 98.5%、94.5% 和 86.9%。与其他定位相比，后叶病理学表现出更高的无再手术生存率（log-rank P = 0.002)。瓣叶病理定位而非修复方法是无再手术生存的独立预测因子（HR 1.455，95% 置信区间 1.098-1.930；P  = 0.009）。

结论

在退行性疾病的微创二尖瓣手术中，与瓣叶切除相比，腱索置换术的围手术期成功率更高。后叶病理是无再手术生存的独立预测因子。