Comparative study on effect of surgery for moderate/severe ischemic mitral regurgitation

doi:10.3969/j.issn.1006-7795.2015.03.003

Abstract

Abstract:

Objective This study aimed to compare effects of surgeries for mitral valve repair and replacement in patients with ischemic mitral regurgitation (IMR), and to determine whether mitral valve operation in different ways will have an impact on patient mortality, survival rate and prognosis. Methods This study included a total of 296 patients, all had moderate to severe chronic ischemic mitral regurgitation.The patients were divided into two groups; on the basis of coronary artery bypass grafting, group 1 received mitral valve repair and group 2 received mitral valve replacement. The patients were followed up for the long term survival rate and heart function, readmission. Finally, the data were analyzed through statistical method. Results 1) No statistically significant differences in baseline data were found between the two groups of patients, and operation details; 2)The operation mortality: No significant difference was found between mitral valve repair group and mitral replacement group (P=0.607);3) Long term survival curve: mitral valve replacement was better than mitral valve repair on the whole (P <0.05); survival rate of mitral valve replacement group patients was better than that of mitral valve repair group when left ventricular ejection fraction was over 30% (P <0.05); survival rate of patients received mitral valve replacement was better than that of patients received mitral valve repair when age was over 65 years (P <0.05); no significant difference was found between mitral valve replacement and mitral valve repair groups in survival rate when left ventricular ejection fraction was less than 30% (P >0.05). 4) In the postoperative ICU, residence time, total hospital stay and cost were significantly better in mitral valve repair group. 5)Echocardiography showed that regurgitation corrective effect was significantly better in mitral valve replacement group than that of the mitral valve repair group. 6)In the rehospitalization rate, no statistically significant differences was found between the two groups. 7)Follow up of heart function in patients after operation, no significant difference was found between two groups. Conclusion 1) For the effect of correction of regurgitation, mitral valve replacement was superior to repair. 2) Operation mortality was not significantly different between two groups. The long-term survival rate of the replacement group was superior to the repair group. 3) To get better prognosis, method of surgery should be chosen based on patients' condition: when left ventricular ejection fraction is over 30%, mitral valve replacement is advised; when patient's age is over 65 years, replacement is advised; when left ventricular ejection fraction is over 30%, either method is good; If patient is young, considering the long-term anticoagulation problems, mitral valve repair is better.

Key words: ischemic mitral regurgitation, coronary artery bypass grafting, mitral valve replacement, mitral valve repair

CLC Number:

R542.5

Yin Bo, Wang Xiaolong, Liu Yuyong, Zheng Tie, Gong Ming, Li Haiyang, Liu Ou, Guan Xinliang, Peng Xiaole, Jiang Wenjian, Huang Qi, Guo Dong, Zhang Hongjia. Comparative study on effect of surgery for moderate/severe ischemic mitral regurgitation[J]. Journal of Capital Medical University, 2015, 36(3): 345-353.

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URL: https://journal03.magtech.org.cn/Jweb_sdykdxxb/EN/10.3969/j.issn.1006-7795.2015.03.003

https://journal03.magtech.org.cn/Jweb_sdykdxxb/EN/Y2015/V36/I3/345

References

[1] Aronson D, Goldsher N, Zukermann R, et al. Ischemic mitral regurgitation and risk of heart failure after myocardial infarction[J]. Arch Intern Med, 2006, 166(21):2362-2368.
[2] Lamas G A, Mitchell G F, Flaker G C, et al. Clinical significance of mitral regurgitation after acute myocardial infarction[J]. Circulation, 1997, 96(3):827-833.
[3] Grigioni F, Enriquez-Sarano M, Zehr K J, et al. Ischemic mitral regurgitation long-term outcome and prognostic implications with quantitative Doppler assessment[J]. Circulation, 2001, 103(13):1759-1764.
[4] Ellis S G, Whitlow P L, Raymond R E, et al. Impact of mitral regurgitation on long-term survival after percutaneous coronary intervention[J]. Am J Cardiol, 2002, 89(3):315-318.
[5] Acker M A, Parides M K, Perrault L P, et al. Mitral-valve repair versus replacement for severe ischemic mitral regurgitation[J]. Engl J Med, 2014, 370(1):23-32.
[6] Burch G, De Pasquale N, Phillips J. Clinical manifestations of papillary muscle dysfunction[J]. Arch Intern Med, 1963, 112:112-117.
[7] Silbiger J J. Mechanistic insights into ischemic mitral regurgitation: echocardiographic and surgical implications[J]. J Am Soc Echocardiogr, 2011, 24(7):707-719.
[8] Bolling S F, Deeb G M, Brunsting L A, et al. Early outcome of mitral valve reconstruction in patients with end-stage cardiomyopathy[J]. J Thorac Cardiovascular Surgery, 1995, 109:676-683.
[9] Braun J, Bax J J, Versteegh M I, et al. Preoperative left ventricular dimensions predict reverse remodeling following restrictive mitral annuloplasty in ischemic mitral regurgitation[J]. Eur J Cardio Thorac Surg, 2005, 27(5):847-853.
[10] McGee E C, Gillinov A M, Blackstone E H, et al. Recurrent mitral regurgitation after annuloplasty for functional ischemic mitral regurgitation[J]. J Thorac Cardiovasc Surg, 2004, 128(6):916-924.
[11] Gelsomino S, Lorusso R, De Cicco G, et al. Five-year echocardiographic results of combined undersized mitral ring annuloplasty and coronary artery bypass grafting for chronic ischaemic mitral regurgitation[J]. Eur Heart J, 2008, 29(2):231-240.
[12] Hung J, Papakostas L, Tahta S A, et al. Mechanism of recurrent ischemic mitral regurgitation after annuloplasty continued LV remodeling as a moving target[J]. Circulation, 2004, 110(11 Suppl 1):Ⅱ85-Ⅱ90.
[13] Magne J, Pibarot P, Dagenais F, et al. Preoperative posterior leaflet angle accurately predicts outcome after restrictive mitral valve annuloplasty for ischemic mitral regurgitation[J]. Circulation, 2007, 115(6):782-791.
[14] Serri K, Bouchard D, Demers P, et al. Is a good perioperative echocardiographic result predictive of durability in ischemic mitral valve repair?[J]. J Thoracic Cardiovascular Surg, 2006, 131(3):565-573. e562.
[15] Chan V, Ruel M, Mesana T G. Mitral valve replacement is a viable alternative to mitral valve repair for ischemic mitral regurgitation: a case-matched study[J]. Ann Thoracic Surg, 2011, 92(4):1358-1366.
[16] Gammie J S, Sheng S, Griffith B P, et al. Trends in mitral valve surgery in the United States: results from the Society of Thoracic Surgeons Adult Cardiac Database[J]. Ann Thoracic Surg, 2009, 87(5):1431-1439.
[17] Grossi E A, Galloway A C, Miller J S, et al. Valve repair versus replacement for mitral insufficiency: when is a mechanical valve still indicated? [J]. J Thorac Cardiovasc Surg, 1998, 115(2):389-396.
[18] Kawachi Y, Oe M, Asou T, et al. Comparative study between valve repair and replacement for mitral pure regurgitation--early and late postoperative results[J]. Jpn Circ J, 1991, 55(5):443-452.
[19] Okita Y, Miki S, Ueda Y, et al. Comparative evaluation of left ventricular performance after mitral valve repair or valve replacement with or without chordal preservation[J]. J H Valve Dis, 1993, 2(2):159-166.
[20] Sand M E, Naftel D C, Blackstone E H, et al. A comparison of repair and replacement for mitral valve incompetence[J]. J Thorac Cardiovasc Surg, 1987, 94(2):208-219.
[21] Crabtree T D, Bailey M S, Moon M R, et al. Recurrent mitral regurgitation and risk factors for early and late mortality after mitral valve repair for functional ischemic mitral regurgitation[J]. Ann Thorac Surgic, 2008, 85(5):1537-1542. discussion 1542-1543.
[22] Lorusso R, Gelsomino S, Vizzardi E, et al. Mitral valve repair or replacement for ischemic mitral regurgitation? The Italian Study on the Treatment of Ischemic Mitral Regurgitation[J]. J Thorac Cardiovasc Surg, 2013, 145(1):128-139.
[23] Russo A, Grigioni F, Avierinos J F, et al. Thromboembolic complications after surgical correction of mitral regurgitationIncidence, predictors, and clinical implications[J]. J Am Coll Cardiol, 2008, 51(12):1203-1211.
[24] Magne J, Girerd N, Sénéchal M, et al. Mitral repair versus replacement for ischemic mitral regurgitation comparison of short-term and long-term survival[J]. Circulation, 2009, 120(11 Suppl):S104-S111.
[25] 李继勇,张健群,伯平,等. 不同保留瓣下结构方法行二尖瓣置换术的对比研究[J]. 心肺血管病杂志, 2014, 529-534.
[26] 李颖,许卫江,刘彬,等心脏瓣膜置换术后围术期心肌梗死的诊治[J].临床误诊误治,2013,26(6):66-68.
[27] 祝岩,王辉山,李新民,等.二尖瓣置换术后迟发型左心室破裂诊治分析[J]. 临床误诊误治,2012,25(9):46-48.
[28] Vassileva C M, Boley T, Markwell S, et al. Meta-analysis of short-term and long-term survival following repair versus replacement for ischemic mitral regurgitation[J]. Eur J Cardio Thorac Surg, 2011, 39(3):295-303.
[29] Rao C, Murphy M O, Saso S, et al. Mitral valve repair or replacement for ischaemic mitral regurgitation: a systematic review[J]. Heart, Lung Circ, 2011, 20(9):555-565.
[30] Dayan V, Soca G, Cura L, et al. Similar survival after mitral valve replacement or repair for ischemic mitral regurgitation: a meta-analysis[J]. Ann Thorac Surgic, 2014, 97:758-765.
[31] 陈曦,李莉.经右胸小切口行微创二尖瓣手术同期行房颤消融术的手术配合[J]. 中国医科大学学报,2014,43(10):944-945.