Objective: To evaluate the clinical outcomes of combined complete preservation of chordal structure mitral valve replacement (C-MVR) with total anatomical arterial myocardial revascularization (TACR) in coronary patients with moderate-to-severe or severe ischemic mitral regurgitation (IMR). Methods: This is a retrospective multi-center case series study. Data were retrospectively collected from 127 patients with coronary artery disease with moderate to severe or severe IMR who received TACR with C-MVR from July 2015 to April 2024 in 13 hospitals in China. There were 90 males and 37 females, aged (56.5±10.7) years (range: 33 to 74 years). Perioperative data and follow-up data including left ventricular ejection fraction, left ventricular end-diastolic diameter, and patency rate of arterial grafts of patients were collected. Comparisons were made using paired sample t-test or χ2 test. Results: In this cohort of 127 patients, 67 underwent concurrent tricuspid valve repair. During surgery, 113 grafts of the left internal mammary artery (LIMA), 127 grafts of the left radial artery, 80 grafts of the right radial artery, and 110 grafts of the right internal mammary artery (RIMA) were harvested. The number of the distal anastomosis was 4.2±0.4 (range: 3 to 5). The aortic cross-clamp time and cardiopulmonary bypass time were (97.5±23.4) minutes (range: 90 to 161 minutes) and (145.4±19.2) minutes (range: 101 to 210 minutes), respectively. There was one operative death. Intraoperative placement of an intra-aortic balloon pump was performed in 21 patients to improve the left ventricular ejection. No sternal ischemic occurred. All patients completed follow-up, with a mean follow-up period of (64.3±7.5) months (range: 4 to 110 months). No major cerebrovascular events occurred during the follow-up period, and all patients survived. Left ventricular ejection fraction improved postoperatively (55.0%±5.3% vs. 41.0%±15.3%, t=17.23, P<0.01). The proportion of patients with New York Heart Association functional class ≤2 increased postoperatively (23.6% (30/127) vs. 87.3% (110/126), χ²=103.77, P<0.01). The proportion of patients with Canadian Cardiovascular Society Angina Classification ≤3 decreased postoperatively (4.8% (6/126) vs. 78.7% (100/127), χ²=142.19, P<0.01). The left ventricular end-diastolic diameter decreased postoperatively ((5.70±4.50) cm vs. (6.10±0.23) cm, t=12.15, P<0.01). Coronary multi-detector computed tomography angiography (MDCTA) follow-up was conducted for (60.5±11.7) months (range: 6 to 109 months) postoperatively. MDCTA confirmed the patency rates of the grafts: 96.4% (108/112) for the LIMA grafts, 88.9% (112/126) for the left radial artery grafts, 93.7% (74/79) for the right radial artery grafts, and 90.9% (100/110) for the free RIMA grafts. No significant differences in graft patency rates were observed between the arterial grafts (χ²=5.24, P=0.155). Conclusion: The results of this multi-centre study demonstrate satisfactory mid-term results of C-MVR with TACR for the treatment of coronary artery disease with moderate to severe or severe IMR.
目的： 探讨同期解剖完全再血管化全动脉冠状动脉旁路移植术（TACR）与保留全部瓣下结构的二尖瓣置换术（C-MVR）治疗冠心病伴中至重度或重度缺血性二尖瓣关闭不全（IMR）的效果。 方法： 本研究为回顾性多中心病例系列研究。回顾性收集2015年7月至2024年4月我国13家医院收治的127例同期接受TACR与C-MVR治疗的冠心病伴中至重度或重度IMR患者的资料。男性90例，女性37例，年龄（56.5±10.7）岁（范围：33~74岁）。收集患者的围手术期资料及随访期间左心室射血分数、左心室舒张末内径、动脉桥通畅率等参数。采用配对样本t检验或χ2检验对数据进行比较。 结果： 127例患者中，67例同期行三尖瓣修复术。术中取带蒂左乳内动脉（LIMA）113支、左桡动脉127支、右桡动脉80支、右乳内动脉（RIMA）110支。远端吻合口数量为（4.2±0.4）个（范围：3~5个）。升主动脉阻断时间与体外循环时间分别为（97.5±23.4）min（范围：90~161 min）与（145.4±19.2）min（范围：101~210 min）。术中死亡1例。21例安装主动脉内球囊反搏以改善左心室射血功能。无患者发生胸骨缺血。除1例术中死亡患者外，术后其余患者完成随访，随访时间（64.3±7.5）个月（范围：4~110个月），期间无重要心脑血管事件发生，患者均存活。左心室射血分数较术前有改善（55.0%±5.3%比41.0%±15.3%，t=17.23，P<0.01），心功能纽约心脏病协会分级≤2级者的比例较术前增加［23.6%（30/127）比87.3%（110/126），χ2=103.77，P<0.01］，心绞痛加拿大心血管学会分级≤3级者的比例较术前减少［4.8%（6/126）比78.7%（100/127），χ2=142.19，P<0.01］，左心室舒张末内径较术前减小［（5.70±4.50）cm比（6.10±0.23）cm，t=12.15，P<0.01］。术后（60.5±11.7）个月（范围：6~109个月）行冠状动脉多排CT血管成像检查，结果显示，LIMA桥通畅率为96.4%（108/112）、左桡动脉桥通畅率为88.9%（112/126），右桡动脉桥通畅率为93.7%（74/79），游离RIMA桥通畅率为90.9%（100/110），各动脉桥之间通畅率的差异无统计学意义（χ2=5.24，P=0.155）。 结论： C-MVR与TACR治疗冠心病伴中至重度或重度IMR的中期结果较满意。.