Palliative surgery versus simple medication therapy for secondary non-ischemic mitral regurgitation: A retrospective cohort study
- VernacularTitle:姑息性手术与单纯药物治疗继发性非缺血性二尖瓣反流的回顾性队列研究
- Author:
Yiwei XU
1
;
Mi ZHOU
1
;
Jiaxi ZHU
1
;
Lei KANG
1
;
Xiaofeng YE
1
;
Jiapei QIU
1
;
Haiqing LI
1
;
Zhe WANG
1
;
Anqing CHEN
1
;
Qiang ZHAO
1
Author Information
1. Department of Cardiovascular Surgery, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, 200032, P. R. China Corresponding author: ZHAO Qiang, Email: zq11607@rjh.com.cn
- Publication Type:Journal Article
- Keywords:
Dilated cardiomyopathy;
secondary mitral valve regurgitation;
mitral valve surgery;
dobutamine stress test
- From:
Chinese Journal of Clinical Thoracic and Cardiovascular Surgery
2024;31(07):1000-1006
- CountryChina
- Language:Chinese
-
Abstract:
Objective To compare the effect of palliative mitral valve surgeries and medication therapies for secondary non-ischemic mitral regurgitation. Methods The clinical data of patients with non-ischemic functional mitral regurgitation treated in our hospital between 2009 and 2019 were retrospectively analyzed. Patients with a left ventricular ejection fraction (LVEF)＜40% underwent a dobutamine stress test, and a positive result was determined when the LVEF improved by more than 15% compared to the baseline value. Positive patients were divided into a surgery group and a medication group. The surgery group underwent surgical mitral valve repair or replacement, while the medication group received simple medication treatment. Follow-up on survival and cardiac function status through outpatient or telephone visits every six months after surgery, and patients underwent cardiac ultrasound examination one year after surgery. The main research endpoint was a composite endpoint of all-cause death, heart failure readmission, and heart transplantation, and the differences in cardiac function and cardiac ultrasound parameters between the two groups were compared. Results Ultimately 41 patients were collected, including 28 males and 13 females with an average age of 55.5±11.1 years. Twenty-five patients were in the surgery group and sixteen patients in the medication group. The median follow-up time was 16 months, ranging 1-96 months. The occurrence of all-cause death in the surgery group was lower than that in the medication group (HR=0.124, 95%CI 0.024-0.641, P=0.034). The difference between the two groups was not statistically significant in the composite endpoint (HR=0.499, 95%CI 0.523-1.631, P=0.229). The New York Heart Association (NYHA) grade of the surgery group was better (NYHA Ⅰ-Ⅱ accounted for 68.0% in the surgury group and 18.8% in the medication group, P<0.01) as well as the grade of mitral valve regurgitation (87.5% of the patients in the medication group had moderate or above regurgitation at follow-up, while all the patients in the surgery group had moderate below regurgitation, P<0.01). There was no statistical difference in preoperative and follow-up changes in echocardiograph parameters between the two groups (P＞0.05). Conclusion For non-ischemic functional mitral regurgitation, if the cardiac systolic function is well reserved, mitral valve surgery can improve survival and quality of life compare to simple medication therapy.
