ObjectiveTo compare the clinical outcomes of mitral valvuloplasty (MVP) and mitral valve replacement (MVR) for infective endocarditis, and to investigate the effect of MVP under different surgical risks. MethodsA retrospective study was done on the patients with mitral infective endocarditis, who underwent surgical treatment in our department from January 2018 to March 2022. According to the procedures, the patients were divided into a MVP group and a MVR group. Propensity score matching method was applied with a ratio of 1:1 to eliminate the biases. The early and midterm outcomes were compared between the two groups after matching. According to the European System for Cardiac Operative Risk Evaluation Ⅱ(EuroSCORE-Ⅱ), the effect of MVP was compared between high and low risk patients. ResultsA total of 195 patients were collected. There were 141 patients in the MVP group (120 males, 85.1%) and 54 patients in the MVR group (41 males, 75.9%). The mean follow-up time was (34.0±16.1) months. Patients in the MVP group were younger [(42.7±14.6) years vs. (56.8±13.0) years, P<0.001] and had better preoperative conditions. The patients in the MVP group had a shorter ICU stay [3.0 (2.0, 5.0) d vs. 4.0 (3.0, 8.0) d, P=0.004], and lower incidences of low cardiac output syndrome (0.7% vs. 9.3%, P=0.007), in-hospital mortality (0.0% vs. 3.7%, P=0.023), and follow-up mortality (4.3% vs. 15.4%, P=0.007). However, after 1:1 propensity score matching, there were no statistical differences in the baseline data or postoperative and follow-up adverse events between the two groups (P>0.05). Also, there was no statistical difference in the mortality of high-risk patients between MVP and MVR group (P>0.05). There was no statistical difference in the reoperation or recurrent severe mitral regurgitation between high and low-risk patients in the MVP group (P>0.05). Conclusion MVP is feasible for treating mitral lesions caused by infective endocarditis with good early and midterm outcomes. For patients with severer preoperative conditions, if the leaflet damage is not severe, MVP may be a viable option, but validation with larger sample sizes is needed.
ObjectiveTo compare short- and medium-term effects of Leonardo da Vinci robot-assisted and traditional mitral valvuloplasty.MethodsWe conducted a retrospective analysis of 74 patients who underwent mitral valvuloplasty in our hospital from January 2015 to March 2017. The patients were divided into two groups according to the mode of operation: a da Vinci group (n=29, 13 males, 16 females at an average age of 52 years) and a routine group (n=45, 18 males, 27 females at an average age of 53 years). The perioperative data of patients in the two groups were compared and analyzed.ResultsThere was no significant difference in sex, age, weight, height, body mass index (BMI), cardiac function (NYHA), hypertension, diabetes, postoperative blood transfusion and postoperative complications between the two groups (P>0.05). The tracheal intubation time, ICU retention time, hospital stay time, blood loss and postoperative drainage in the da Vinci group were shorter or less than those in the routine group (P<0.05). The operation time, cardiopulmonary bypass time and aortic clamping time in the da Vinci group were longer than those in the routine group (P<0.05). Different surgical procedures had no significant effect on left atrial diameter (LAD), left ventricular end-diastolic diameter (LVEDD), left ventricular ejection fraction (LVEF) and mitral regurgitation (MR) 3 years after operation. There was no interaction between the mode of operation and the time of follow-up. There was no significant difference in echocardiographic evaluation in the same period (P>0.05).ConclusionDa Vinci operation shortens the rehabilitation process of patients compared with traditional surgery. For short- and medium-term follow-up results, there is no difference between Leonardo da Vinci and traditional mitral valve surgeries, and the clinical effect of da Vinci robot-assisted mitral valvuloplasty is satisfactory, which is worthy of further clinical promotion.
Objective To evaluate a score system to allow stratification of complexity in degenerative mitral valve repair. Methods We retrospectively reviewed the clinical data of 312 consecutive patients who underwent surgery for mitral valve repair and whose preoperative echocardiography was referable in our hospital from January 2012 to December 2013. A scoring system for surgical complexity was used based mainly on the preoperative echocardiography findings. Complexity of mitral valve repair was scored as 1 to 9, and patients were categorized into 3 groups based on the score for surgical complexity: a simple group (1 point), an intermediate group (2-4 points) and a complex group (≥5 points). There were 86 males and 35 females in the simple group (n=121) with an average age of 51.6±12.6 years, 105 males and 53 females in the intermediate group (n=158) with an average age of 51.1±12.8 years and 25 males and 8 females in the complex group (n=33) with an average age of 49.3±13.0 years. Results There was significant difference in surgical complexity in different groups. In the simple, intermediate and complex groups, the mean cardiopulmonary bypass time was 111.7±45.5 min, 117.7±40.4 min and 153.4±74.2 min (P<0.001), the mean cross-clamping time was 77.5±33.8 min, 83.2±29.9 min and 108.8±56.2 min (P<0.001), and the mean number of repair techniques utilized was 2.1±0.4, 2.4±0.6 and 2.8±0.8 (P<0.001). However, there was no significant difference in the early and late outcomes in different groups. Conclusion It is feasible to use echocardiography to quantitatively evaluate the difficulty of mitral valvuloplasty.
目的 总结68例二尖瓣成形术的临床经验，评估其术后临床效果。 方法 回顾分析2001年12月－2011年12月进行二尖瓣成形术治疗的68例二尖瓣关闭不全患者的临床资料。成形术的方法为：人工瓣环植入、双孔成形、后瓣矩形切除、赘生物切除及心包补片修复、腱索转移等。术中采用注水实验和经食管超声心动图检查评估成形效果。 结果 68例患者中手术死亡2例，二次开胸止血1例，肺部感染3例。全部患者术中注水实验和食管超声心动图检查显示成形效果满意。存活66例患者随访6个月，术后10 d、6个月彩色多普勒超声心动图检查：左心房内径、左心室舒张末内径缩小。术后6个月彩色多普勒超声心动图检查：无或微量反流33例，轻度反流27例，轻～中度反流5例，中度反流1例。 结论 根据二尖瓣关闭不全的特征，选择相应的二尖瓣成形技术，可以取的较好的临床效果。
ObjectiveTo summarize our clinical experience and improve clinical outcomes of chordal transfer and artificial chordae in mitral valvuloplasty (MVP). MethodsClinical data of 74 patients who received chordal transfer or artificial chordae in MVP for the treatment of anterior mitral leaflet prolapse[degenerative mitral regurgitation (MR)] from January 2008 to February 2013 were retrospectively analyzed. There were 34 male and 40 female patients with their age of 22-64 (48.00±6.40)years. According to different surgical techniques, all the 74 patients were divided into 2 groups. In the chordal transfer group, there were 42 patients who received chordal transfer with posterior leaflet chordae transferred to anterior leaflet. In the artificial chordae group, there were 32 patients who received artificial chordae with loop technique. Postoperative mortality, morbidity and MR were analyzed. Left ventricular ejection fraction (LVEF), left ventricular end-diastolic diameter (LVEDD)and end-systolic diameter (LVESD)were examined by echocardiography during follow-up. ResultsThere was no perioperative death in either group. Two patients underwent reexploration for postoperative bleeding. Nine patients had paroxysmal atrial fibrillation postoperatively, and were cured by intravenous administration of amiodarone. Echocardiography before discharge showed mild MR in 5 patients, trivial MR in 12 patients, and none MR in 25 patients in the chordal transfer group, and mild MR in 6 patients, trivial MR in 15 patients and none MR in 11 patients in the artificial chordae group. Seventy patients[94.59%(70/74)] were followed up after discharge. In both groups, LVEF at 6 months after MVP was significantly higher than that before discharge (chordal transfer group:64.00%±4.20% vs. 55.00%±5.10%; artificial chordae group:63.00%±3.50% vs. 56.00%±4.20%). LVEDD (chordal transfer group:47.00±2.20 mm vs. 58.00±6.90 mm; artificial chordae group:45.00±3.80 mm vs. 57.00±5.10 mm, P < 0.05)and LVESD at 6 months after MVP were significantly smaller than preoperative values. There was no statistical difference in LVEF, LVEDD or LVESD preop-eratively, before discharge and 6 months after MVP respectively between the chordal transfer group and artificial chordae group (P > 0.05). One patient in the chordal transfer group underwent mitral valve replacement for severe MR 14 months after MVP. One patient in the artificial choadae group underwent mitral valve replacement for persistent hemoglobinuria 6 months after MVP. ConclusionChordal transfer and artificial chordae technique are both suitable for the treatment of complex anterior leaflet prolapse. Artificial chordae has wider range of application, and chordae transfer needs advanced and flexible surgical skills. Both techniques have good short-term clinical outcomes and deserve clinical application.
ObjectiveTo evaluate the effectiveness of mitral valve repair for mitral regurgitation. MethodsWe retrospectively analyzed the clinical data of 47 patients underwent mitral repair in General Hospital of Ningxia Medical University between January 2010 and June 2014 year. There were 36 males and 11 females with age of 10 months to 65 years, mean age of 42.38±15.27 years. ResultsThere was no operative death within follow-up time of 18±7 months (ranged 14 to 1 586 days). Mitral valve function was normal or traces regurgitation in 33 patients (70.21%). Mild mitral regurgitation occurred in 11 patients (23.40%). Postoperative transesophageal echocardiography showed that 2 patients (4.26%) had moderate regurgitation. They underwent mitral valve repair again and cured. One patient (2.13%) underwent mitral valve replacement because of moderate to severe regurgitation. The dimensions of left atrium and left ventricle obviously decreased and heart function improved significantly compared with preoperative ones. ConclusionStrict control of surgical indications for different valve disease, the use of mitral valve repair technique, mitral surgery can get a good clinical efficacy. Preoperative diagnosis by transesophageal echocardiography, intraoperative monitoring, and immediate postoperative assessment for mitral valve repair results provide good technical support.
Objective To compare the clinical outcomes and safety of minimally invasive and routine mitral valve repair or replacement for patients with single mitral valve disease. Methods We retrospectively analyzed the clinical data of 67 patients with single mitral valve disease （without aortic valve and tricuspid valve lesion or other heart diseases including atrial septal defect） who underwent mitral valve repair or replacement in the First Affiliated Hospital of China Medical University between January and July 2011. The patients were divided into two groups according to different surgical approaches：the minimally invasive surgery group （n=29，8 males and 21 females，age 51.4±9.4 years） underwent minimally invasive mitral valve repair or replacement via right mini-thoractomy；and the routine surgery group （n=38，11 males and 27 females，age 53.6±11.9 years） underwent mitral valve repair or replacement via middle sternotomy. In the minimally invasive surgery group，9 patients underwent mitral valve repair while the other 20 patients underwent mitral valve replacement. And no patient underwent transition to routine operation. In the routine surgery group，15 patients underwent mitral valve repair and 23 patients underwent mitral valve replacement. Clinical outcomes and safety of the operations were compared between the two groups. Results There was no statistical difference in operation time between the two groups （207.9±18.1 min versus 198.4±27.5 min，P=0.076）. The amount of postoperative drainage （126.7±34.5 ml versus 435.6±87.2 ml，P=0.000） and blood transfusion （red blood cell 1.4±0.8 U versus 2.3±1.1 U，P=0.000；blood plasma 164.3±50.4 ml versus 405.6±68.9 ml，P=0.000） of the minimally invasive surgery group were significantly lower than those of the routine surgery group. The cardiopulmonary bypass time （81.7±23.9 min versus 58.7±13.6 min，P=0.000） and aortic-clamping time （51.6±12.7 min versus 38.4±11.7 min，P=0.000） of the minimally invasive surgery group were significantly longer than those of the routine surgery group. The length of ICU stay （22.5±3.6 h versus 31.7±8.5 h，P=0.000），mechanical ventilation （7.4±3.2 h versus 11.2±5.1 h，P=0.000） and postoperative hospitalization （7.1±1.6 d versus 13.5±2.4 d，P=0.000） of the minimally invasive surgery group were significantly shorter than those of the routine surgery group. There was no statistical difference in postoperative complications between the two groups. Minimally invasive surgery group patients were followed up for 5.3±2.4 months with a follow-up rate of 72.4%（21/29）. Routine surgery group patients were followed up for 5.5±3.8 months with a follow-up rate of 71.0%（27/38）. There was no significant complication during follow-up in both two groups. Conclusion Minimally invasive mitral valve operation via right mini-thoracotomy is effective and safe with a good cosmetic result. Compared with routine operation，patients undergoing minimally invasive operation recover better and faster.