Mitral Valve Repair for Degenerative MR With Moderate or Less Tricuspid Regurgitation: 2-Year Outcomes From a Multicenter Echocardiographic Core Laboratory-Adjudicated Cohort.

The purpose of this study was to evaluate 2-year survival and MR recurrence in patients who underwent MV repair for DMR with concomitant tricuspid valve (TV) disease between 2016 and 2018.

本研究的目的是评估2016年至2018年间因DMR接受MV修复并伴有三尖瓣（TV）疾病的患者的2年生存率和MR复发情况。

Methods

This is a post hoc analysis of outcomes from a randomized trial (N = 401; 39 sites) evaluating the effects of TV repair during MV surgery for patients with DMR and moderate or less tricuspid regurgitation.

这是一项事后分析，评估了在二尖瓣手术中对有DMR和中度或更轻度三尖瓣反流患者进行三尖瓣修复的效果，数据来自一项随机试验（N = 401；39个研究地点）。

Eighty-seven patients (21.7%) were excluded because they underwent MV replacement (32 planned and 9 conversions) or did not have isolated DMR or evaluable echocardiographic data during 2 years.

有87名患者（21.7%）被排除在外，因为他们接受了二尖瓣置换术（32例计划内和9例转换）或在2年内没有孤立的DMR或可评估的超声心动图数据。

The primary endpoint was a composite of the incidenceof all-cause mortality, recurrent severe MR, or MV reoperation (ie, treatment failure) during 2 years.

主要终点是所有原因死亡率、复发性重度MR或MV再次手术（即治疗失败）在2年内的发生率的复合指标。

Multivariable modeling identified risk factors for recurrent MR.

多变量建模确定了复发性MR的风险因素。

Results

Among 314 eligible patients (median age: 67.4; female: 24.2%), 1.0% (3 of 307) had moderate MR and 0.7% (2 of 307) had severe MR at discharge.

在314名符合条件的患者中（中位年龄：67.4岁；女性：24.2%），1.0%（307名患者中有3名）在出院时有中度MR，0.7%（307名患者中有2名）在出院时有重度MR。

Thirty-day all-cause mortality rate was 1.0%.

30天全因死亡率为1.0%。

At 2 years, 3.5% (11 of 314) had died, and 2.2% (7 of 314) had MV reoperation.

在2年时，3.5%（11/314）的患者死亡，2.2%（7/314）的患者进行了机械通气（MV）再手术。

Among 295 survivors free of MV reoperation with evaluable echocardiograms, 9.2% (27 of 295) had moderate MR, 1.4% (4 of 295) had severe MR, and 2.5% (7 of 275) had a mean MV gradient >5 mm Hg.

在295名无MV再手术且超声心动图可评估的存活者中，9.2%（27/295）的患者有中度二尖瓣反流（MR），1.4%（4/295）的患者有重度MR，且2.5%（7/275）的患者的平均二尖瓣梯度>5毫米汞柱。

The incidenceof death, MV reoperation, or severe MR during 2 years was 8.0% (25 of 313).

在2年期间，死亡、再次机械通气或重度二尖瓣反流的发生率为8.0%（313例中有25例）。

Patients with anterior or bileaflet MV pathology were at higher risk for treatment failure compared with patients with posterior leaflet pathology (OR: 2.48; 95% CI: 1.09-5.68; P = 0.03).

与后叶病变患者相比，前叶或双叶病变患者治疗失败的风险更高（OR: 2.48; 95% 置信区间: 1.09-5.68; P = 0.03）。

Conclusions

In this international trial with echocardiographic core laboratory adjudication, the rate of survival free from MV reoperation or any episode of severe MR during 2 years was 92% in patients with DMR and concomitant TV disease.

在这项国际试验中，通过超声心动图核心实验室的裁定，患有DMR和合并TV疾病的患者在2年内无需进行MV再手术或任何严重MR事件的生存率为92%。

These outcomes show that surgical repair achieves high success and durability during 2 years in these patients, providing a contemporary benchmark for clinical decision-making and future trials.

这些结果表明，手术修复在这些患者中在2年内取得了高成功率和持久性，为临床决策和未来试验提供了当代基准。

(Evaluating the Benefit of Concurrent Tricuspid Valve Repair During Mitral Surgery; NCT02675244).

(在二尖瓣手术中同时进行三尖瓣修复的益处评估; NCT02675244).