内镜二尖瓣修复中人工腱索：手术技术与长期结局的比较分析
该单中心回顾性研究分析了2001至2023年间1186例接受微创二尖瓣修复的患者，其中581例使用人工腱索（151例单根ePTFE腱索，430例预测量腱索环）。中位随访5.0年，两种技术在死亡或再次手术的累积发生率、10年无事件生存率上无显著差异；腱索环技术缩短了主动脉阻断时间并增加了植入腱索数量，但技术选择并非长期结局的独立预测因子。
要点
- 预测量腱索环与单根ePTFE腱索的长期修复耐久性和无事件生存率相当。
- 腱索环技术主动脉阻断时间更短（100 vs 121 min，p<0.001）且植入腱索数量更多（5.0 vs 2.0，p<0.001）。
- 左心耳封堵是长期成功的唯一独立预测因子（HR 0.11，95%CI 0.014-0.839，p=0.033）。
核心结论
- 单根人工腱索与预测量腱索环在微创二尖瓣修复中均提供优异的围术期和长期结局，技术选择不影响长期结局。
研究设计与样本
- 2001至2023年奥地利因斯布鲁克大学医院连续1186例微创二尖瓣修复患者的围术期数据与长期结局回顾性分析，按二尖瓣研究联盟标准报告。
- 其中581例接受人工腱索：151例单根ePTFE腱索，430例预测量腱索环；采用竞争风险分析处理长期死亡风险。
主要发现
- 队列平均年龄60.6±12.6岁，男性占61.6%；中位随访5.0（4.45-5.53）年，1年、5年、10年生存率分别为98.4%、95.4%、92.7%。
- 15年死亡或再次手术累积发生率：腱索环组8.5%，单根ePTFE腱索组11.0%（p=0.90），风险比0.95（95%CI 0.44-2.06）。
- 腱索环技术主动脉阻断时间更短（100 vs 121 min，p<0.001），植入腱索数量更多（5.0 vs 2.0，p<0.001）。
- 10年无事件生存率：腱索环组92%（87-97%），单根ePTFE腱索组93%（89-97%），p=0.5。
- 左心耳封堵是长期成功的唯一独立预测因子（HR 0.11，95%CI 0.014-0.839，p=0.033），技术选择不影响长期结局。
临床怎么用
- 在微创二尖瓣修复中，预测量腱索环可缩短主动脉阻断时间并提高腱索植入效率，且不损害长期修复耐久性。
- 技术选择（单根腱索 vs 腱索环）不应作为长期结局的决策依据；合并左心耳封堵可能与更好的长期成功相关。
以上解读依据论文摘要（全文未开放获取或许可不允许翻译转载）。
原文
BACKGROUND: The use of artificial chords for mitral valve prolapse during minimally invasive mitral valve repair (MIMVR) has increased over the past two decades, driven by advancements in surgical techniques and the need for reproducible and durable repair strategies. This study aimed to compare the outcomes of single artificial chords versus premeasured loops and identify predictors for long-term success. METHODS: Between 2001-2023, perioperative data and long-term outcomes of 1186 consecutive patients who underwent MIMVR at the University Hospital Innsbruck, Austria were analysed and reported according to the Mitral Valve Research Consortium criteria, including all-cause mortality, freedom from reoperation and technical success defined as freedom from reoperation or recurrent mitral regurgitation>moderate. A competing risk analysis was performed to account for the risk of mortality long-term. RESULTS: The mean age of the cohort was 60.6±12.6 years, with 61.6% males. Among them, 581 patients received artificial chords (151 single chords and 430 premeasured loops). At a median follow-up of 5.0 (4.45-5.53) years, survival was 98.4%, 95.4% and 92.7% at 1, 5 and 10 years, respectively. At 15 years, cumulative incidence of death or reoperation was 8.5% in the loop group and 11.0% in the single expanded polytetrafluoroethylene (ePTFE) chord group (p=0.90), with a hazard ratio of 0.95 (95% CI 0.44 to 2.06). The loop technique was associated with shorter cross-clamp times (100 vs 121 min, p<0.001) and more implanted chords (5.0 vs 2.0, p<0.001) compared with the ePTFE chord technique. There was no significant difference in long-term success: event-free survival at 10 years: 92% (87-97%) in the loops group versus 93% (89-97%) in the single ePTFE chords group, p=0.5. Left atrial appendage occlusion emerged as the only independent predictor for long-term success (HR: 0.11 (0.014-0.839), p=0.033), whereas the choice of technique did not influence long-term outcomes. CONCLUSIONS: Both single artificial chords and premeasured loops provided excellent perioperative and long-term outcomes in MIMVR. The loop technique facilitated shorter operative times and greater chordal implantation efficiency without compromising long-term repair durability or event-free survival.
引用
- Nägele F, Gollmann-Tepeköylü C, Splika J, et al. Artificial chords in endoscopic mitral valve repair: a comparative analysis of surgical techniques and long-term outcomes. Heart. 2026. PMID: 42009573. doi:10.1136/heartjnl-2026-327812
供执业医师工作参考，不替代临床判断；数值与分级以指南原文为准。