초록접수 현황
| 16F-177 | 구연 발표 |
Consequences of Recurrent Mitral Regurgitation Following Mitral Valve Repair in Patients with Degenerative Mitral Regurgitation and Risk Factors for Recurrence
Jung-Hwan Kim, Seung Hyun Lee, Hyun-Chel Joo, Sak Lee, Young-Nam Youn, Kyung-Jong Yoo, Byung-Chul Chang
Department of Cardiovascular Surgery, Severance Cardiovascular Hospital, Yonsei University College of Medicine, Seoul, Korea
Background : To study of the consequences of recurrent mitral regurgitation (MR) after mitral valve repair in patients with degenerative MR and identify risk factors for recurrence.
Methods : From January 1990 to December 2015, total 1111 patients underwent mitral valve repair. We excluded who had mitral stenosis, concomitant aortic valve surgery, tricuspid valve replacement, ischemic MR, or non-degenerative MR such as rheumatic heart disease or endocarditis. Total 792 patients underwent mitral valve repair due to degenerative MR and included in this study. Recurrent MR was defined as more than grade 2 MR at follow-up echocardiography. The mean follow-up duration was 6.55±5.41 years (Range, 0.01-25.17 years).
Results : The mean age was 52.9±14.1 years and the mean left ventricular ejection fraction was 66.6±8.4%. During follow-up period, MR recurred for 133 (16.8%) patients and free-from recurrence rate at 20 years was 71.5±2.8%. Among them, degree of MR decreased in only 8 (6.0%) patients and aggravated in 46 (34.6%) patients. And mitral re-operation was performed in 41 (5.2%) patients and free-from re-operation rate at 20 years was 77.5%±6.1%. Recurrent MR was associated with increased mortality (HR:2.020, 95% CI:1.016-4.017, p=0.045) and adverse left ventricular remodeling. Independent risk factors for MR recurrence were low BSA (HR:1.835, 95% CI:1.170-2.878, p=0.008), repair before 2000 (HR:1.858, 95% CI:1.172-2.946, p=0.008), high LVEDD (HR:1.030, 95% CI:1.007-1.053, p=0.011), anterior leaflet prolapse (HR:2.003, 95% CI:1.404-2.857, p<0.001), multiple segments prolapse (HR:1.920, 95% CI:1.281-2.878, p=0.002), and residual MR at discharge (HR:5.944, 95% CI:4.058-8.706, p<0.001).
Conclusion : Our study demonstrated that recurrent MR after mitral repair in patients with degenerative MR showed tendency to progress and was associated with increased mortality and adverse left ventricular remodeling. The outcomes of repair had been improved over time, but anterior leaflet and multiple segments prolapse remained risk for recurrence.
Methods : From January 1990 to December 2015, total 1111 patients underwent mitral valve repair. We excluded who had mitral stenosis, concomitant aortic valve surgery, tricuspid valve replacement, ischemic MR, or non-degenerative MR such as rheumatic heart disease or endocarditis. Total 792 patients underwent mitral valve repair due to degenerative MR and included in this study. Recurrent MR was defined as more than grade 2 MR at follow-up echocardiography. The mean follow-up duration was 6.55±5.41 years (Range, 0.01-25.17 years).
Results : The mean age was 52.9±14.1 years and the mean left ventricular ejection fraction was 66.6±8.4%. During follow-up period, MR recurred for 133 (16.8%) patients and free-from recurrence rate at 20 years was 71.5±2.8%. Among them, degree of MR decreased in only 8 (6.0%) patients and aggravated in 46 (34.6%) patients. And mitral re-operation was performed in 41 (5.2%) patients and free-from re-operation rate at 20 years was 77.5%±6.1%. Recurrent MR was associated with increased mortality (HR:2.020, 95% CI:1.016-4.017, p=0.045) and adverse left ventricular remodeling. Independent risk factors for MR recurrence were low BSA (HR:1.835, 95% CI:1.170-2.878, p=0.008), repair before 2000 (HR:1.858, 95% CI:1.172-2.946, p=0.008), high LVEDD (HR:1.030, 95% CI:1.007-1.053, p=0.011), anterior leaflet prolapse (HR:2.003, 95% CI:1.404-2.857, p<0.001), multiple segments prolapse (HR:1.920, 95% CI:1.281-2.878, p=0.002), and residual MR at discharge (HR:5.944, 95% CI:4.058-8.706, p<0.001).
Conclusion : Our study demonstrated that recurrent MR after mitral repair in patients with degenerative MR showed tendency to progress and was associated with increased mortality and adverse left ventricular remodeling. The outcomes of repair had been improved over time, but anterior leaflet and multiple segments prolapse remained risk for recurrence.
책임저자: Byung-Chul Chang
Department of Cardiovascular Surgery, Severance Cardiovascular Hospital, Yonsei University College of Medicine, Seoul, Korea
발표자: Jung-Hwan Kim, E-mail : jhkim0907@yuhs.ac