The Annals of thoracic surgery · 2018
Durability at 19 Years of Quadrangular Resection With Annular Plication for Mitral Regurgitation.
Оценочное исследованиеСтатьяНазвание и аннотация: Перевод пока не подготовлен
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Lapenna Elisabetta, Del Forno Benedetto, Amore Ludovica, Ruggeri Stefania, Iaci Giuseppe, Schiavi Davide, Belluschi Igor, Bargagna Marta, Alfieri Ottavio, De Bonis Michele
Аннотация
BACKGROUND: We report the long-term (19 years) clinical and echocardiographic results of the quadrangular resection with annular plication and annuloplasty.
METHODS: Included were 145 consecutive patients (mean age, 58 ± 11.1 years; left ventricular ejection fraction, 0.59 ± 0.095) with severe degenerative mitral regurgitation due to posterior leaflet prolapse/flail who underwent quadrangular resection of the posterior leaflet combined with ring (127 patients [87.5%]) or pericardium (18 patients [12.5%]) annuloplasty.
RESULTS: No hospital deaths occurred. At hospital discharge, all patients but 1 had none or trivial mitral regurgitation. Follow-up was 97% complete (median, 19 years; interquartile range, 18 to 20 years). At 20 years, the overall survival was 74% ± 3.7%. At 19 years, cumulative incidence function of cardiac death with noncardiac death as a competing risk was 9.9% ± 2.5% (95% confidence interval [CI], 5.7% to 15.5%). Age was the only significant predictor of cardiac death (hazard ratio, 1.1; 95% CI, 1.0 to 1.1; p = 0.01) at multivariate analysis. Only 6 patients (4%) were reoperated on for recurrent severe mitral regurgitation. At 19 years, cumulative incidence function of reoperation and recurrence of mitral regurgitation 3+ or higher with death as a competing risk was 4.3% ± 1.7% (95% CI, 1.7% to 8.8%) and 8.8% ± 2.8% (95% CI, 4.3% to 15.5%), respectively. Indeed, only 11 patients (8%) had recurrent mitral insufficiency 3+ or higher. No predictor of reoperation and recurrence of mitral regurgitation 3+ or higher was identified. At the last follow-up, moderate mitral regurgitation (2+/4+) was detected in 14 patients (10%).
CONCLUSIONS: Quadrangular resection with annular plication for posterior leaflet prolapse, combined with annuloplasty, is associated with a very low probability of reoperation and recurrent mitral regurgitation for up to 2 decades after the operation. These results provide reference values to which all of the other more recently introduced surgical and transcatheter options need to be compared.
METHODS: Included were 145 consecutive patients (mean age, 58 ± 11.1 years; left ventricular ejection fraction, 0.59 ± 0.095) with severe degenerative mitral regurgitation due to posterior leaflet prolapse/flail who underwent quadrangular resection of the posterior leaflet combined with ring (127 patients [87.5%]) or pericardium (18 patients [12.5%]) annuloplasty.
RESULTS: No hospital deaths occurred. At hospital discharge, all patients but 1 had none or trivial mitral regurgitation. Follow-up was 97% complete (median, 19 years; interquartile range, 18 to 20 years). At 20 years, the overall survival was 74% ± 3.7%. At 19 years, cumulative incidence function of cardiac death with noncardiac death as a competing risk was 9.9% ± 2.5% (95% confidence interval [CI], 5.7% to 15.5%). Age was the only significant predictor of cardiac death (hazard ratio, 1.1; 95% CI, 1.0 to 1.1; p = 0.01) at multivariate analysis. Only 6 patients (4%) were reoperated on for recurrent severe mitral regurgitation. At 19 years, cumulative incidence function of reoperation and recurrence of mitral regurgitation 3+ or higher with death as a competing risk was 4.3% ± 1.7% (95% CI, 1.7% to 8.8%) and 8.8% ± 2.8% (95% CI, 4.3% to 15.5%), respectively. Indeed, only 11 patients (8%) had recurrent mitral insufficiency 3+ or higher. No predictor of reoperation and recurrence of mitral regurgitation 3+ or higher was identified. At the last follow-up, moderate mitral regurgitation (2+/4+) was detected in 14 patients (10%).
CONCLUSIONS: Quadrangular resection with annular plication for posterior leaflet prolapse, combined with annuloplasty, is associated with a very low probability of reoperation and recurrent mitral regurgitation for up to 2 decades after the operation. These results provide reference values to which all of the other more recently introduced surgical and transcatheter options need to be compared.
Предметные рубрики MeSH
Age FactorsAgedCohort StudiesEchocardiographyFemaleHumansItalyKaplan-Meier EstimateMaleMiddle AgedMitral Valve AnnuloplastyMitral Valve InsufficiencyMitral Valve ProlapsePrognosisProportional Hazards ModelsRetrospective StudiesRisk AssessmentSeverity of Illness IndexSex FactorsSurvival RateSurvivorsTime FactorsTreatment Outcome