Journal of cardiac surgery · 2019
Mitral valve annuloplasty versus no intervention for mild-to-moderate secondary mitral regurgitation in severe aortic regurgitation: a propensity-score matched analysis.
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Lin Yi, Yin Kanhua, Zhang Zhiqi, Yang Zhaohua, Guo Changfa, Wang Fenglei, Wang Yulin, Wang Chunsheng
Аннотация
BACKGROUND: The management strategy for secondary mitral regurgitation (MR) during aortic valve surgery for aortic regurgitations (ARs) remains controversial. This study aimed to compare the outcomes between mitral valve annuloplasty (MVP) and no intervention for managing 2+ or 3+ MR among severe patients with AR.
METHODS: Eighty-seven eligible patients with complete echocardiographic follow-up were included, with 51 patients in the MVP group and 36 in the No-MVP group. The MVP group had a larger left atrial (LA) diameter (44.2 ± 6.6 vs 49.4 ± 7.6 mm; P = .001) and a higher proportion of 3+ MR (33.3% vs 76.5%; P < .001) than the No-MVP group. After 1:1 propensity-score matching, the patients treated with and without MVP were balanced on 14 preoperative characteristics.
RESULTS: There was one in-hospital death in each group. In the propensity-score matched cohort, there was no statistically significant difference between the two groups in the cumulative incidence of residual 2+ MR during a follow-up of 26.4 ± 14.8 months (P = .64). The No-MVP group was associated with a more significant change in the left ventricular end-diastolic dimension (18.1 ± 7.9 vs 13.7 ± 8.7 mm; P = .02), while the changes in the LA diameter, left ventricular end-systolic dimension, and left ventricular ejection fraction were similar between the two groups.
CONCLUSIONS: The severity of MR and the LA size may impact surgeons' decisions. MVP does not seem to add extra benefits to the outcomes, and it may be associated with worse left ventricular remodeling.
METHODS: Eighty-seven eligible patients with complete echocardiographic follow-up were included, with 51 patients in the MVP group and 36 in the No-MVP group. The MVP group had a larger left atrial (LA) diameter (44.2 ± 6.6 vs 49.4 ± 7.6 mm; P = .001) and a higher proportion of 3+ MR (33.3% vs 76.5%; P < .001) than the No-MVP group. After 1:1 propensity-score matching, the patients treated with and without MVP were balanced on 14 preoperative characteristics.
RESULTS: There was one in-hospital death in each group. In the propensity-score matched cohort, there was no statistically significant difference between the two groups in the cumulative incidence of residual 2+ MR during a follow-up of 26.4 ± 14.8 months (P = .64). The No-MVP group was associated with a more significant change in the left ventricular end-diastolic dimension (18.1 ± 7.9 vs 13.7 ± 8.7 mm; P = .02), while the changes in the LA diameter, left ventricular end-systolic dimension, and left ventricular ejection fraction were similar between the two groups.
CONCLUSIONS: The severity of MR and the LA size may impact surgeons' decisions. MVP does not seem to add extra benefits to the outcomes, and it may be associated with worse left ventricular remodeling.