Mitral valve repair or replacement in hypertrophic obstructive cardiomyopathy: a prospective randomized study

被引:24
作者
Bogachev-Prokophiev, Alexander [1 ]
Afanasyev, Alexander [1 ]
Zheleznev, Sergey [1 ]
Fomenko, Michael [1 ]
Sharifulin, Ravil [1 ]
Kretov, Eugenie [1 ]
Karaskov, Alexander [1 ]
机构
[1] Minist Hlth Russian Federat, Siberian Biomed Res Ctr, Dept Heart Valves Surg, 15 Rechkunovskaya St, Novosibirsk 630055, Russia
关键词
Hypertrophic cardiomyopathy; Myectomy; Mitral regurgitation; Mitral valve replacement; Mitral valve repair; LEAFLET RETENTION PLASTY; SUSTAINED IMPROVEMENT; SUBAORTIC STENOSIS; SEPTAL MYECTOMY; REGURGITATION; EXTENSION; GUIDELINES; TERM;
D O I
10.1093/icvts/ivx152
中图分类号
R5 [内科学];
学科分类号
1002 ; 100201 ;
摘要
OBJECTIVES: The optimal surgical strategy for concomitant mitral valve intervention during myectomy remains controversial. The purpose of this study was to compare the results of mitral valve replacement versus repair in patients with hypertrophic obstructive cardiomyopathy and severe mitral regurgitation. METHODS: Between 2010 and 2013, a total of 88 patients with hypertrophic obstructive cardiomyopathy and severe mitral regurgitation were randomly assigned to undergo either mitral valve replacement or repair in addition to extended myectomy. RESULTS: Three patients from the repair group were switched to mitral valve replacement after repair failure. There was 1 early death (2.4%) in the replacement group. The resting left ventricular outflow tract gradient was reduced from 89.1 +/- 20.4 to 18.3 +/- 5.7mmHg (P < 0.001) and from 96.6 +/- 28.1 to 14.7 +/- 5.9mmHg (P < 0.001) in the replacement and repair groups, respectively; there was no significant difference between the groups (P = 0.458). At 2-year follow-up, overall survival was 87.2 +/- 4.9% and 96.7 +/- 3.3% (P = 0.034); freedom from sudden cardiac death was 95.6 +/- 3.1% and 96.7 +/- 3.3% (P = 0.615); and freedom from thromboembolic events was 91.2 +/- 4.2% and 100%, respectively (P = 0.026). CONCLUSIONS: Both mitral valve repair and valve replacement in addition to extended myectomy are effective methods of surgical treatment in patients with hypertrophic obstructive cardiomyopathy who have severe mitral regurgitation. The benefits of mitral valve repair are better overall survival and a lower rate of thromboembolic events.
引用
收藏
页码:356 / 362
页数:7
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