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.
■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。