Key result
Total pericardial mitral annuloplasty demonstrated comparable 7-year freedom from reoperation and recurrent mitral regurgitation compared to prosthetic mitral annuloplasty (96.3% vs 96.4%, p=0.914).
Why the study?
The study aimed to compare the durability of total pericardial annuloplasty versus total prosthetic ring annuloplasty in treating degenerative, ischemic, and non-ischemic functional mitral regurgitation.
Does total pericardial annuloplasty provide comparable durability to prosthetic annuloplasty in patients with mitral regurgitation?
Cohort (n=280)
No
Does total pericardial annuloplasty provide comparable durability to prosthetic annuloplasty in patients with mitral regurgitation?
Autopericardial mitral annuloplasty offers comparable 7-year durability and survival to prosthetic rings at a significantly lower cost.
Pericardial annuloplasty was associated with equivalent 7-year durability; leaves open its role as lower-cost option pending randomized trials.
CĂl: Srovnat totĂĄlnĂ anuloplastiku s pouĹžitĂm perikardu (pericardial annuloplasty, PeMA) s totĂĄlnĂ anuloplastikou s pouĹžitĂm protetickĂŠho prstence (prosthetic annuloplasty, PrMA) z hlediska trvanlivosti v lĂŠÄbÄ degenerativnĂ, ischemickĂŠ i neischemickĂŠ funkÄnĂ mitrĂĄlnĂ regurgitace (MR). Metody: ZpÄtnÄ jsme zkontrolovali prospektivnÄ shromaĹžÄovanĂŠ Ăşdaje 280 pacientĹŻ, u nichĹž byla v letech 2008 aĹž 2015 po valvuloplastice provedena buÄ PeMA (50,4 %), nebo PrMA (s pouĹžitĂm anuloplastickĂ˝ch prstencĹŻ Carpentier-Edwards Physio; 49,6 %). Mezi kombinovanĂŠ vĂ˝kony patĹily: 40Ă CABG (PeMA - 18, PrMA - 22); 13Ă ablace spolu s odstranÄnĂm ouĹĄka levĂŠ sĂnÄ (PeMA - 8, PrMA - 5); 7Ă plastika mitrĂĄlnĂ chlopnÄ (PeMA - 2, PrMA - 5); 9Ă uzĂĄvÄr defektu septa sĂnĂ (PeMA - 3, PrMA - 6). VĂ˝sledky: TĹicetidennĂ mortalita Äinila 0,4 %. PrĹŻmÄrnĂĄ dĂŠlka sledovĂĄnĂ skonÄila v 95,7 % pĹĂpadĹŻ po 83,4 ± 13,0 mÄsĂcĂch. VĂ˝kony byly v sedmiletĂŠm horizontu srovnatelnĂŠ: nulovĂĄ nutnost reoperace a recidiva MR = 2+/3+ (PeMA 96,3 %; PrMA 96,4 %; p = 0,914); nepĹĂtomnost komplikacĂ (PeMA 86,5 %; PrMA 89,2 %; p = 0,174); pĹeĹžitĂ (PeMA 96,5 %; PrMA 97,8 %; p = 0,238). CelkovĂŠ sedmiletĂŠ pĹeĹžitĂ dosĂĄhlo hodnoty 97,1 %. Podle multivariaÄnĂ analĂ˝zy byly vysokĂ˝ vÄk a ischemickĂĄ choroba srdeÄnĂ = 2+/3+ (p = 0,027; HR = 1,131, resp. p = 0,030; HR = 2,002) vĂ˝znamnĂ˝mi prediktory reoperace a recidivy MR i nezĂĄvislĂ˝mi predikÄnĂmi faktory kratĹĄĂho pĹeĹžitĂ (p = 0,029; HR = 4,251, resp. p = 0,040; HR = 1,135). V multivariaÄnĂ analĂ˝ze vysokĂĄ hodnota ejekÄnĂ frakce levĂŠ komory negativnÄ korelovala s niŞťĂm rizikem reoperace a recidivy MR = 2+/3+ (p = 0,006; HR = 0,786) a pĹĂznivÄjĹĄĂ dĂŠlkou pĹeĹžitĂ (p = 0,013; HR = 0,718). ZĂĄvÄry: PĹi dobĹe provedenĂŠ valvuloplastice mĹŻĹže mĂt perikardiĂĄlnĂ prstenec stejnou trvanlivost jako prstenec Physio a pĹi pouĹžitĂ dokonalejĹĄĂch metod fixace mĹŻĹže bĂ˝t trvanlivost i delĹĄĂ. Pokud se tĂ˝Äe ceny, pĹedstavuje perikardiĂĄlnĂ prstenec lepĹĄĂ volbu, protoĹže nestojĂ nic, zatĂmco cena prstence Physio je pĹibliĹžnÄ 600 USD. ProtetickĂŠ prstence nejsou vĹždy spojeny s rozvojem endokarditidy, tromboembolie, kalcifikace chlopnÄ ani hemolytickou anĂŠmiĂ.
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Sidiki et al. (2020) conducted a cohort in Mitral regurgitation (n=280). Total pericardial mitral annuloplasty (PeMA) vs. Total prosthetic mitral annuloplasty (PrMA) was evaluated on 7-year freedom from reoperation and recurrent MR = 2+/3+ (p=0.914). Total pericardial mitral annuloplasty demonstrated comparable 7-year freedom from reoperation and recurrent mitral regurgitation compared to prosthetic mitral annuloplasty (96.3% vs 96.4%, p=0.914).
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