PDF(Pubmed)
Abstract：
UNASSIGNED: Treatment of moderate functional mitral regurgitation (FMR) during aortic valve replacement (AVR) is controversial. This study aimed to evaluate the effect of different surgical strategies in patients with moderate FMR undergoing AVR.
UNASSIGNED: A total of 468 patients with moderate FMR undergoing AVR from January 2010 to December 2019 were retrospectively studied comparing 3 different surgical strategies, namely isolated AVR, AVR + mitral valve repair (MVr) and AVR + mitral valve replacement (MVR). Survival was estimated using the Kaplan-Meier method and compared with the log-rank test, followed by inverse probability treatment weighting (IPTW) analysis to adjust the between-group imbalances. The primary outcome was overall mortality.
UNASSIGNED: Patients underwent isolated AVR (35.3%), AVR + MVr (30.3%), or AVR + MVR (34.4%). The median follow-up was 27.1 months. AVR + MVR was associated with better improvement of FMR during the early and follow-up period compared to isolated AVR and AVR + MVr (p < 0.001). Compared to isolated AVR, AVR + MVR increased the risk of mid-term mortality (hazard ratio [HR]: 2.13, 95% confidence interval [CI]: 1.01-4.48, p = 0.046), which was sustained in the IPTW analysis (HR: 4.15, 95% CI: 1.69-10.15, p = 0.002). In contrast, AVR + MVr showed only a tendency to increase the risk of follow-up mortality (HR: 1.63, 95% CI: 0.72-3.67, p = 0.239), which was more apparent in the IPTW analysis (HR: 2.54, 95% CI: 0.98-6.56, p = 0.054).
UNASSIGNED: In patients with severe aortic valve disease and moderate FMR, isolated AVR might be more reasonable than AVR + MVr or AVR + MVR.
UNASSIGNED: A total of 468 patients with moderate FMR undergoing AVR from January 2010 to December 2019 were retrospectively studied comparing 3 different surgical strategies, namely isolated AVR, AVR + mitral valve repair (MVr) and AVR + mitral valve replacement (MVR). Survival was estimated using the Kaplan-Meier method and compared with the log-rank test, followed by inverse probability treatment weighting (IPTW) analysis to adjust the between-group imbalances. The primary outcome was overall mortality.
UNASSIGNED: Patients underwent isolated AVR (35.3%), AVR + MVr (30.3%), or AVR + MVR (34.4%). The median follow-up was 27.1 months. AVR + MVR was associated with better improvement of FMR during the early and follow-up period compared to isolated AVR and AVR + MVr (p < 0.001). Compared to isolated AVR, AVR + MVR increased the risk of mid-term mortality (hazard ratio [HR]: 2.13, 95% confidence interval [CI]: 1.01-4.48, p = 0.046), which was sustained in the IPTW analysis (HR: 4.15, 95% CI: 1.69-10.15, p = 0.002). In contrast, AVR + MVr showed only a tendency to increase the risk of follow-up mortality (HR: 1.63, 95% CI: 0.72-3.67, p = 0.239), which was more apparent in the IPTW analysis (HR: 2.54, 95% CI: 0.98-6.56, p = 0.054).
UNASSIGNED: In patients with severe aortic valve disease and moderate FMR, isolated AVR might be more reasonable than AVR + MVr or AVR + MVR.
摘要：
■主动脉瓣置换术（AVR）期间中度功能性二尖瓣反流（FMR）的治疗存在争议。本研究旨在评估不同手术策略对接受AVR的中度FMR患者的影响。
■回顾性研究了2010年1月至2019年12月进行AVR的468例中度FMR患者，比较了3种不同的手术策略。即孤立的AVR，AVR+二尖瓣修复术(MVr)和AVR+二尖瓣置换术(MVR)。使用Kaplan-Meier方法估计生存率，并与对数秩检验进行比较，其次是逆概率处理加权(IPTW)分析，以调整组间不平衡。主要结果是总死亡率。
■患者接受孤立性AVR（35.3%），AVR+MVr(30.3%),或AVR+MVR（34.4%）。中位随访时间为27.1个月。与孤立的AVR和AVR+MVr相比，AVR+MVR在早期和随访期间与FMR的更好改善相关（p<0.001）。与孤立的AVR相比，AVR+MVR增加了中期死亡率的风险(风险比[HR]:2.13,95%置信区间[CI]:1.01-4.48,p=0.046),在IPTW分析中保持不变（HR：4.15，95%CI：1.69-10.15，p=0.002）。相比之下,AVR+MVr仅显示出增加随访死亡率风险的趋势(HR:1.63,95%CI:0.72-3.67,p=0.239),这在IPTW分析中更为明显(HR:2.54,95%CI:0.98-6.56,p=0.054)。
■在患有严重主动脉瓣疾病和中度FMR的患者中，隔离的AVR可能比AVR+MVr或AVR+MVR更合理。
■回顾性研究了2010年1月至2019年12月进行AVR的468例中度FMR患者，比较了3种不同的手术策略。即孤立的AVR，AVR+二尖瓣修复术(MVr)和AVR+二尖瓣置换术(MVR)。使用Kaplan-Meier方法估计生存率，并与对数秩检验进行比较，其次是逆概率处理加权(IPTW)分析，以调整组间不平衡。主要结果是总死亡率。
■患者接受孤立性AVR（35.3%），AVR+MVr(30.3%),或AVR+MVR（34.4%）。中位随访时间为27.1个月。与孤立的AVR和AVR+MVr相比，AVR+MVR在早期和随访期间与FMR的更好改善相关（p<0.001）。与孤立的AVR相比，AVR+MVR增加了中期死亡率的风险(风险比[HR]:2.13,95%置信区间[CI]:1.01-4.48,p=0.046),在IPTW分析中保持不变（HR：4.15，95%CI：1.69-10.15，p=0.002）。相比之下,AVR+MVr仅显示出增加随访死亡率风险的趋势(HR:1.63,95%CI:0.72-3.67,p=0.239),这在IPTW分析中更为明显(HR:2.54,95%CI:0.98-6.56,p=0.054)。
■在患有严重主动脉瓣疾病和中度FMR的患者中，隔离的AVR可能比AVR+MVr或AVR+MVR更合理。
