초록접수 현황
| 14F-243 | 포럼 발표 |
Management Outcomes of Primary Severe Mitral Regurgitation in Patients with Far-advanced Left Ventricular Dysfunction: Is Surgical Management Feasible?
박성준, 김준범, 정성호, 주석중, 정철현, 이재원
울산대학교 의과대학 서울아산병원 흉부외과학교실
Background : The benefit of surgical repair of primary severe mitral regurgitation (MR) in patients with far-advanced left ventricular (LV) dysfunction has been debated. We aimed to evaluate the long-term outcomes of these patients according to the initial management intentions.
Methods : Out of 2,620 patients who were diagnosed with severe MR from 1995 through 2013, we identified 46 patients (age 52.2±14.6, 14 females) with MR of leaflet pathology and far-advanced LV dysfunction (LV ejection fraction [EF] <30% and/or LV end-systolic dimension [LVESD] >55mm).
Results : Thirty six patients received surgery (SURG group) whereas 10 patients were managed with medical therapy (MED group) as the initial intention-to-treat basis. SURG group patients were younger (P=0.004), and had lower creatinine clearance (P=0.014) and LVEF (P=0.028). Twenty six patients in the SURG group underwent mitral repair and 10 patients received chordae sparing valve replacement. Clinical follow-up was possible in all subjects (median, 86.8 months; quartile 1-3, 25.3-140.8 months). Adverse outcomes included 2 early (5.6%) and 7 late deaths in the SURG group, and 4 deaths, 2 heart transplantations and 2 deferred mitral surgeries in the MED group. The overall survival rates tended to be higher in the SURG group (At 5 years, 79.5±7.0% vs. 60.0±15.5%, P=0.37), whereas event-free survival was significantly superior in the SURG group than the MED group (79.5±7.0% vs. 30.0±15.5%, P=0.001; Figure). On long-term echocardiographic assessments (35/40 late survivors [> 6 months]; median, 72.8 months; quartile 1-3, 20.8-111.4 months), the SURG group showed significant LV reverse remodeling (LVESD, from 58.2±5.1mm to 45.2±11.8mm, P<0.001) while the MED group did not (LVESD, from 60.2±8.6mm to 61.2±10.1mm, P=0.46).
Conclusion : In selected patients with primary severe MR and advanced LV dysfunction, the prompt surgery could be performed safely and was associated with an excellent long-term outcomes as well as favorable LV reverse remodeling.
Methods : Out of 2,620 patients who were diagnosed with severe MR from 1995 through 2013, we identified 46 patients (age 52.2±14.6, 14 females) with MR of leaflet pathology and far-advanced LV dysfunction (LV ejection fraction [EF] <30% and/or LV end-systolic dimension [LVESD] >55mm).
Results : Thirty six patients received surgery (SURG group) whereas 10 patients were managed with medical therapy (MED group) as the initial intention-to-treat basis. SURG group patients were younger (P=0.004), and had lower creatinine clearance (P=0.014) and LVEF (P=0.028). Twenty six patients in the SURG group underwent mitral repair and 10 patients received chordae sparing valve replacement. Clinical follow-up was possible in all subjects (median, 86.8 months; quartile 1-3, 25.3-140.8 months). Adverse outcomes included 2 early (5.6%) and 7 late deaths in the SURG group, and 4 deaths, 2 heart transplantations and 2 deferred mitral surgeries in the MED group. The overall survival rates tended to be higher in the SURG group (At 5 years, 79.5±7.0% vs. 60.0±15.5%, P=0.37), whereas event-free survival was significantly superior in the SURG group than the MED group (79.5±7.0% vs. 30.0±15.5%, P=0.001; Figure). On long-term echocardiographic assessments (35/40 late survivors [> 6 months]; median, 72.8 months; quartile 1-3, 20.8-111.4 months), the SURG group showed significant LV reverse remodeling (LVESD, from 58.2±5.1mm to 45.2±11.8mm, P<0.001) while the MED group did not (LVESD, from 60.2±8.6mm to 61.2±10.1mm, P=0.46).
Conclusion : In selected patients with primary severe MR and advanced LV dysfunction, the prompt surgery could be performed safely and was associated with an excellent long-term outcomes as well as favorable LV reverse remodeling.
책임저자: 이재원
울산대학교 의과대학 서울아산병원 흉부외과학교실
연락처 : 박성준, Tel: 02-3010-3580 , E-mail : sungjun0919@naver.com
