ObjectiveTo investigate the restoration of left atrial function and its relationship with atrial fibrosis of patients after mitral valve replacement (MVR)and concomitant radiofrequency ablation (RFA)for atrial fibrillation (AF). MethodsClinical data of 32 patients with mitral valve disease and chronic AF who underwent surgical treatment in General Hospital of Shenyang Military Area Command from January to August 2010 were retrospectively analyzed in this cohort study. There were 11 male and 21 female patients with their age of 49.8±8.7 years. There were 14 patients with rheumatic mitral stenosis (MS), 8 patients with rheumatic MS and mitral regurgitation, and 10 patients with mitral valve prolapse. Preoperative AF duration was 3.6±4.6 years. All the patients received MVR and concomitant RFA for AF. According to the cutting off extent of left atrial fibrosis (10.9%), all the 32 patients were divided into 2 groups. There were 19 patients with more severe left atrial fibrosis ( > 10.9%)in group A and 13 patients with milder left atrial fibrosis ( < 10.9%)in group B. Immunohistochemistry was performed to examined left atrial fibrosis, and echocardiography was performed to examined the structure and function of left atrium. ResultsThere was no perioperative death. Cardiopulmonary bypass time was 84.6±22.6 minutes, aortic cross-clamping time was 47.6±15.6 minutes, and ICU stay was 3.2±1.5 days. All the 32 patients were followed up for longer than 6 months (1.3±0.6 years). The extent of left atrial fibrosis of the 32 patients was 4.8%-18.3% (10.7%±4.2%). There was no statistical difference in left atrial diameter (LAD), left atrial fractional area change (LAFAC)or mitral annular motion between group A and group B preoperatively and 3 months after surgery respectively (P > 0.05). At 6 month after surgery, LAD of group B was significantly smaller than that of group A (P < 0.05), late diastolic mitral annular velocity (Am)of group B was significantly higher than that of group A (P < 0.05), and there was also some improvement in LAFAC of group B compared with group A (P=0.067). Among the 32 patients, 28 patients (87.5%)restored sinus rhythm (SR)3 months after surgery, and 21 patients (65.6%)maintained SR longer than 6 months after surgery. Patients in group B were more likely to maintain SR than patients in group A (P=0.010). ConclusionImprovement of left atrial function can be observed 6 month after MVR and concomitant RFA for AF, which is related to the extent of left atrial fibrosis.
Objective To analyze the clinical efficacy and survival outcome of totally thoracoscopic redo mitral valve replacement and evaluate its efficiency and safety. Methods The clinical data of patients with totally thoracoscopic redo mitral valve replacement in Guangdong Provincial People’s Hospital between 2013 and 2019 were retrospectively analyzed. Survival analysis was performed using the Kaplan-Meier method. Univariate and multivariate Cox regression analyses were used to determine the risk factors for postoperative death. Results There were 48 patients including 29 females and 19 males with a median age of 53 (44, 66) years. All the procedures were performed successfully with no conversion to median sternotomy. A total of 15, 10 and 23 patients received surgeries under non-beating heart, beating heart and ventricular fibrillation, respectively. The in-hospital mortality rate was 6.25% (3/48), and the incidence of early postoperative complications was 18.75% (9/48). Thirty-five (72.92%) patients had their tracheal intubation removed within 24 hours after the operation. The 1- and 6-year survival rates were 89.50% (95%CI 81.30%-98.70%) and 82.90% (95%CI 71.50%-96.20%), respectively. Age>65 years was an independent risk factor for postoperative death (P=0.04). Conclusion Totally thoracoscopic redo mitral valve replacement is safe and reliable, with advantages of rapid recovery, reducing blood transfusion rate, reducing postoperative complications and acceptable long-term survival rate. It is worthy of being widely popularized in the clinic.
ObjectiveTo evaluate the in-hospital and long-term outcomes of patients receiving mitral valve replacement with mechanical or biological prosthesis.MethodsThe clinical data of patients undergoing mitral valve replacement in our center between January 2005 and August 2018 were retrospectively analyzed. Patients with emergency, reoperation, bleeding or embolic events or incomplete clinical data were ruled out.ResultsTotally 569 patients were enrolled, including 325 with mechanical prosthesis (a mechanical prosthesis group, 111 males and 214 females with a mean age of 55.54±4.09 years) and 244 bioprosthesis (a bioprosthesis group, 90 males and 154 females with a mean age of 60.02±4.28 years). There was no significant difference in the in-hospital mortality between the two groups (P=0.250). The survival rate at postoperative 15 years of the bioprosthesis group was higher than that of mechanical prosthesis group (78.69% vs. 66.25%, χ2=8.844, P=0.003). No remarkable differences were found in prosthesis failure (P=0.183) and thromboembolism events (P=0.505) between the two groups. Bleeding occurred more frequently in the mechanical prosthesis group (P=0.040). After the propensity-score matched analysis based on the age, the survival rate was still higher in the bioprosthesis group than in the mechanical prosthesis group (P=0.032).ConclusionBiological prosthesis can be considered as the preferable choice in mitral valve replacement procedure in order to improve the long-term survival and decrease the frequent of bleeding events.
Objective To examine the regression, residue, or progression of tricuspid regurgitation （TR） after mitral valve replacement so as to improve the clinical evaluation and management of TR. Methods From January 1998 to December 2003, a total of 287 consecutive patients of mitral valve replacement were followed and reviewed for this study. There were 86 male patients and 201 female patients whose ages ranged from 15 to 66 years （41.0±11.0 years）. The predominant mitral vane lesion was stenosis in 199 patients （69%）, regurgitation in 66 patients （23%） and mixed in 22 patients （8%）. A total of 201 patients （70%） had atrial fibrillation and 86 patients （30%） were in sinus rhythm. According to ratio of maximal regurgitation area to right atrial area TR was graded as mild （＋）, mild-moderate （＋/＋＋） moderate （＋＋） moderate-severe （＋＋/＋＋＋） and severe （＋＋＋）. There were 101 mild TR （36.7%）, 5 mild-moderate（1.8%）, 27 moderate （9.8%）, 2 moderate-severe （0.7%） and 21 severe （7.6%）. Depending on the surgical findings tricuspid annuloplasty was performed. The patients were followed in outpatient clinical and had echocardiography evaluation regularly. Results The follow-up ranged from 2 to 7 years （4.0±1.6 years）. Twelve patients were lost during the follow-up periods. Compared with preoperation, clinical condition of the majority of patients was improved after surgery. The diameter of left atrium, right atrium, left ventricle and right ventricle decreased significantly after operation （P〈0.01）. The ejection fraction and fraction of shorting increased significantly after surgery （P〈0.05）. However there were no significantly changes between pre- TR and post- TR in these patients （P〉0.05）. Tricuspid annuloplasty was not performed for 129 patients who had TR because TR was judged intraoperatively not to be severe. Of those patients, TR regressed in 54 patients, improved in 12 patients, did not change in 46 patients and progressed in 17 patients respectively after surgery. There were 27 patients who received De Vega tricuspid annuloplasty. Among them, TR regressed in 10 patients, improved in 12 patients and did not change in 5 patients respectively after surgery. Conclusion It is not adequate to evaluate the degree of TR in mitral valve diseases with rate of maximal regurgitation area to right atrial area. It should be improved to adopt intraoperative findings for tricuspid annuloplasty. TR may occur in patients who do not have TR before operation.
Abstract: Objective To observe the longterm condition of patients after mitral valve replacement with or without mild aortic valve regurgitation (AR) and discuss whether treatment of AR is necessary during the course of mitral valve replacement. Methods From March 1999 to April 2004, 88 patients who underwent mitral valve replacement (with or without mild AR before surgery) in West China Hospital of Sichuan University were followed up for 5 years or more. The patients were divided into two groups according to whether they had mild AR based on the result of preoperative echocardiography examination. In the AR group, there were 35 patients including 7 males and 28 females aged 49.26±11.87. By the New York Heart Association (NYHA) grading system before surgery, 4 patients were classified as Class Ⅱ, 26 Class Ⅲ and 5 Class Ⅳ. In the nonAR group, there were 53 patients including 7 males and 46 females aged 48.59±10.22. Using the NYHA grading system before surgery, we found there were 7 patients with Class Ⅱ cardiac function, 39 Class Ⅲ and 7 Class Ⅳ. After operation, all patients were followed up regularly and 5 years after surgery, patients were examined by echocardiography again. Results The followup period ranged from 5 to 9 years (6.39±1.26). There was no statistical difference in gender (P=0.394), age (P=0.841), preoperative cardiac function (P=0.960) and cardiac rhythm (P=0.732) between the two groups. For the AR group, after operation, NYHA heart function, left ventricle ejection fraction (LVEF) and left ventricle fraction shortening (LVFS) significantly increased or improved(Plt;0.05). In the nonAR group, after operation, NYHA heart function and LVEF significantly improved (Plt;0.05), while LVFS had no significant change (Pgt;0.05). Left [CM(159mm]ventricular dimensions (LVD) and aortic dimensions between the two groups had no significant difference afteroperation (Pgt;0.05). There was no significant difference in the number of AR cases before and after surgery (Pgt;005) in the AR group, while there was a significant difference in the nonAR group (Plt;0.05). Conclusion For patients with mild AR who underwent mitral valve surgery 5 to 9 years ago, there is little change in their AR condition. There is no need to treat mild AR preventively during the course of mitral valve replacement.