Long-Term Results of Mitral Valve Repair

Abstract Introduction: Current guidelines state that patients with severe mitral regurgitation should be treated in reference centers with a high reparability rate, low mortality rate, and durable results. Objective: To analyze our global experience with the treatment of organic mitral regurgitation from various etiologies operated in a single center. Methods: We evaluated all surgically treated patients with organic mitral regurgitation from 2004-2017. Patients were evaluated clinically and by echocardiography every year. We determined early and late survival rates, valve related events and freedom from recurrent mitral regurgitation and tricuspid regurgitation. Valve failure was defined as any mitral regurgitation ≥ moderate degree or the need for reoperation for any reason. Results: Out of 133 patients with organic mitral regurgitation, 125 (93.9%) were submitted to valve repair. Mean age was 57±15 years and 52 patients were males. The most common etiologies were degenerative disease (73 patients) and rheumatic disease (34 patients). Early mortality was 2.4% and late survival was 84.3% at 10 years, which are similar to the age- and gender-matched general population. Only two patients developed severe mitral regurgitation, and both were reoperated (95.6% at 10 years). Freedom from mitral valve failure was 84.5% at 10 years, with no difference between degenerative and rheumatic valves. Overall, late ≥ moderate tricuspid regurgitation was present in 34% of the patients, being more common in the rheumatic ones. The use of tricuspid annuloplasty abolished this complication. Conclusion: We have demonstrated that mitral regurgitation due to organic mitral valve disease from various etiologies can be surgically treated with a high repair rate, low early mortality and long-term survival that are comparable to the matched general population. Concomitant treatment of atrial fibrillation and tricuspid valve may be important adjuncts to optimize long-term results.

**引言**：当前临床指南明确指出，重度二尖瓣反流（mitral regurgitation）患者需在具备高瓣膜修复成功率、低手术死亡率及持久临床疗效的诊疗中心接受治疗。
**研究目的**：分析单中心对不同病因所致器质性二尖瓣反流患者的外科治疗整体临床经验。
**研究方法**：纳入2004年至2017年间所有接受外科治疗的器质性二尖瓣反流患者。对所有患者每年开展临床评估与超声心动图（echocardiography）检查，统计其早期与远期生存率、瓣膜相关不良事件发生率，以及无复发性二尖瓣反流、三尖瓣反流的比例。本研究将瓣膜失效定义为：出现中度及以上程度的二尖瓣反流，或因任何原因需接受再次手术。
**研究结果**：本研究共纳入133例器质性二尖瓣反流患者，其中125例（93.9%）接受了瓣膜修复手术。患者平均年龄为57±15岁，男性52例。最常见的病因依次为退行性病变（73例）与风湿性病变（34例）。患者早期死亡率为2.4%，术后10年远期生存率为84.3%，与年龄、性别匹配的普通人群无显著差异。仅2例患者术后出现重度二尖瓣反流，且均接受了再次手术（术后10年无严重反流比例为95.6%）。术后10年无瓣膜失效比例为84.5%，退行性病变与风湿性病变患者的该指标无统计学差异。整体而言，34%的患者出现了中度及以上远期三尖瓣反流，该并发症在风湿性病变患者中更为多见。术中联合应用三尖瓣瓣环成形术（tricuspid annuloplasty）可有效消除该并发症。
**研究结论**：本研究证实，针对不同病因所致器质性二尖瓣瓣膜病变引发的二尖瓣反流，外科治疗可实现较高的修复成功率、较低的早期死亡率，且远期生存率与年龄、性别匹配的普通人群相当。术中联合治疗心房颤动与三尖瓣病变，或是优化远期临床疗效的重要辅助策略。