Abstract： Compared with mitral valve replacement, there areseveral advantages in mitral valvuloplasty, so recently more and more sights are caught on mitral valve repair. According to different etiology, the surgeon can apply annuloplasty, triangular resection, quadrangular resection, replacement or transposition of chordae tendineae and so on to treat mitral regurgitation(MR). With the development of minimally invasive surgical technology, robotic mitral valve reconstruction evolve rapidly and percutaneous interventional therapy also commence from lab to bedside.We believe surgeons can repair MR safely and successfully in the majority of patients with proficiency in the basic techniques.
ObjectiveTo evaluate outcomes of mitral valvuloplasty with artificial chord and mitral annuloplasty ring in patients with mitral valve prolapse. MethodsFrom January 2012 to March 2014, mitral valvuloplasty with artificial chord and mitral annuloplasty ring were performed for 58 patients with mitral valve prolapsed in Department of Cardiovascular Surgery, Fujian Provincial Hospital, among which 47 simple anterior or posterior mitral valvuloplasty and 11 combined anterior-posterior mitral valvuloplasty were completed. There were 33 males and 25 females aged (53.7±14.3) years. ResultsThere was no in-hospital death. Three patients received mitral valve replacement. The transoesophageal echocardiography found no or trivial mitral regurgitation in 48 patients, mild mitral regurgitation in 7 patients. The diameter of the left atrium (LA) and left ventricle (LV), left ventricular end-diastolic volume (LVEDV) and left ventricular end-systolic volume (LVESV) were significantly decreased after the operation. During the follow-up of 6 months to 2 years, the cardiac function of the patients improved. ConclusionMitral valvuloplasty with artificial chord and mitral annuloplasty ring is simple, reliable and effective treatment for patients with mitral valve prolapse, and its shortand mid-term outcome is good.
ObjectiveTo summarize mid- to long-term results of edge to edge mitral repair for mitral regurgitation (MR). MethodsClinical data of 31 patients who underwent edge to edge mitral repair in Nanjing Drum Tower Hospital from June 2002 to June 2008 were retrospectively reviewed. There were 13 male and 18 female patients with their age of 14-77 (43±21) years. Clinical and echocardiographic data were analyzed. ResultsThree patients died in hospital,and 28 patients finished mid- to long-term follow-up for 5-10 years. During follow-up, 1 patient died of acute decompensated heart failure in the 2nd year after discharge. Two patients had recurrent moderate MR, and 6 patients had recurrent moderate-to-severe MR including 3 patients who underwent mitral valve replacement in the 5th,6th and 7th postoperative year respectively because of severe MR. Five-year reoperation-free rate was 88.9% (24/27). Five-year mortality was 3.6% (1/28). The incidence of recurrent moderate or severe MR within 5 postoperative years was 28.6% (8/28). ConclusionFor complex MR or as an emergency substitute strategy for failed routine mitral valvuloplasty, edgeto- edge mitral repair can produce good mid- to long-term outcomes except for Carpentier Ⅲb MR.
ObjectiveTo analyze risk factors of early outcomes of mitral valvuloplasty (MVP)for the treatment of degenerative mitral regurgitation (DMR). MethodsClinical data of 132 DMR patients who underwent MVP in Fu Wai Hospital between January 1, 2011 and November 1, 2011 were retrospectively analyzed. A total of 114 patients (86.4%)were followed up after discharge with their mean age of 51.21±12.78 years, including 76 males (66.7%). Preoperative risk factors of early outcomes of MVP were analyzed. ResultsAmong those patients, there were 25 patients with atrial fibri-llation (AF)(21.9%). Preoperative ejection fraction was 63.88%±6.93%. Preoperative echocardiography showed left ventricular end-diastolic diameter (LVEDD)was 31.61±5.51 mm/m2. There were 66 patients (57.9%)with tricuspid regurg-itation, and 34 patients (29.8%)underwent concomitant tricuspid valvuloplasty including 10 patients (8.8%)who received tricuspid annuloplasty rings. Two patients died postoperatively, 2 patients underwent re-operation of mitral valve replacement or MVP respectively. Postoperative echocardiography showed moderate or severe mitral regurgitation in 15 patients. Preoperative risk factors of early outcomes of MVP included AF (36.8% vs. 18.9%, P=0.035), large LVEDD (34.02±3.76 mm/m2 vs. 31.15±5.68 mm/m2, P=0.042)and functional mitral regurgitation (15.8% vs. 1.1%, P=0.007). Multivariate analysis showed greater postoperative LVEDD reduction significantly lowered the incidence of postoperative events (HR 0.002, 95% CI < 0.001-0.570, P=0.031). ConclusionsEnlargement of the left ventricle is an independent preoperative risk factor for early outcomes of MVP for DMR patients. Greater postoperative LVEDD reduction significantly lowers the incidence of postoperative events.
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.
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 investigate clinical outcomes of mitral valvuloplasty (MVP)for the treatment of infective endocarditis (IE)and mitral regurgitation (MR). MethodsFrom March 2002 to January 2012, 33 patients with IE and MR underwent MVP in Fu Wai Hospital. There were 23 male and 10 female patients with their age of 10-67 (35.7±17.8)years. Thirteen patients had previous cardiac anomalies. Preoperatively, there were 5 patients with mild MR, 15 patients with moderate MR and 13 patients with severe MR. There were 5 patients in New York Heart Association (NYHA)functional classⅠ, 23 patients in classⅡ, 4 patients in classⅢ and 1 patient in classⅣ. All the patients received MVP including 14 patients received MVP in active phase of IE. Concomitantly, 6 patients received aortic valve replacement, 5 patients received tricuspid valvuloplasty, 1 patient received coronary artery bypass grafting, 1 patient received resection of left atrial myxoma and 1 patient received repair of aortic sinus aneurysm. Surgical procedures included pericardial patch closure of leaflet perforation in 5 patients, leaflet excision and suturing in 17 patients, double-orifice method in 3 patients, chordae transfer and artificial chordae implantation in 5 patients, and annuloplastic ring implantation in 15 patients. ResultsOne patient died of acute myocardial infarction 7 days after the operation. All other 32 patients were successfully discharged. Echocardiography before discharge showed left ventricular end-diastolic diameter (LVEDD, 48.9±7.6 mm)and left atrial diameter (LAD, 31.7±7.4 mm)were significantly smaller than preoperative values (P=0.000). Thirty-two patients were followed up for 6-125 (73.0±38.6)months. There was no death, IE recurrence, bleeding or thromboembolism during follow-up. One patient received mitral valve replacement for mitral stenosis 3 years after discharge. There were 25 patients in NYHA func-tional classⅠ, 5 patients in classⅡand 2 patients in classⅢ. There were 4 patients with mild MR, 1 patient with moderate MR, and 26 patients had no MR. One patient had faster mitral inflow at diastolic phase (1.7 m/s). One patient had moderate aortic regurgitation. LVEDD and LAD during follow-up were not statistically different from those before discharge. Left ventricular ejection fraction during follow-up was significantly higher than that before discharge (60.9%±6.6% vs. 57.5%±6.7%, P=0.043). ConclusionMVP is a reliable surgical procedure for patients with IE and MR, and can significantly reduce left atrial and left ventricular diameter and improve cardiac function postoperatively.
Objective To analyze early and midterm outcomes and summarize clinical experience of mitral valve repair with artificial chordae for degenerative mitral regurgitation （MR）. Methods Clinical data of 78 patients with degenerative MR who underwent mitral valve repair with Gore-Tex artificial chordae from October 2008 to December 2011 in General Hospita1 of Shenyang Military Command were retrospectively analyzed. There were 47 male patients and 31female patients with their age of 52.7±9.6 years，who all had degenerative MR. Operation techniques included simple GoreTex artificial chordae replacement in 15 patients，artificial chordae replacement plus quadrangular resection of the posterior leaflet in 58 patients，artificial chordae replacement plus quadrangular resection of the posterior leaflet and Sliding technique in 5 patients. One to three （2.15±1.05） Gore-Tex artificial chordae were used for each patient，and annuloplasty ring was used for all the patients. Thirty-nine patients underwent concomitant tricuspid valvuloplasty. Intraoperative transesophagealechocardiography showed none obvious MR in 62 patients，trivial MR in 13 patients and mild MR in 3 patients. All thepatients were followed up after discharge. Echocardiography was used to evaluate heart function and MR degree duringfollow-up. Results There was no in-hospital death in this group. Postoperative complications included sinus bradycardiain 5 patients，supraventricular tachycardia in 8 patients，late cardiac tamponade in 1 patient，and permanent pacemakerimplantation in 1 patient. Seventy patients were followed up for 1-2 years with the follow-up rate of 89.74% （70/78）. Duringfollow-up，1 patient died of cerebral embolism 13 months after discharge，and all the other patients remained alive. There were 60 patients with NYHA classⅠand 9 patients with NYHA classⅡ. Echocardiography at 1 year after dischargeshowed that left atrial diameter，left ventricular end-diastolic diameter，left ventricular end-systolic diameter，and pulmonary artery systolic pressure were significantly smaller or lower than preoperative values （P＜0.05），left ventricular ejection fraction （68.00%±7.00% vs. 55.00%±6.00%） and cardiac output were significantly higher than preoperative values（P＜0.05），and MR degree （ratio of regurgitation beam area and left atrial area） was significantly reduced compared with preoperative MR degree （3.45%±5.56% vs. 39.55%±9.86%，P＜0.05）. No artificial chordae rupture was found. There were47 patients without MR and 22 patients with trivial MR during follow-up. Conclusion Gore-Tex artificial chordae replacement is a safe and effective surgical technique for the treatment of degenerative MR.
ObjectiveTo attempt an innovative mitral valvuloplasty by chained double stitching without shaping ring to repair ischemic mitral regurgitation (IMR) and to evaluate the clinical efficacy of this new procedure. MethodsWe retrospectively analyzed the clinical data of 12 patients with coronary artery disease and IMR underwent the innovative mitral valvuloplasty by chained double stitching without shaping ring in our hospital from August 2012 to December 2013. There were 10 males and 2 females at the mean age of 60±10 years ranging from 42 to 76 years. The cardiac functional parameters and condition of mitral regurgitation were compared among the period of preoperation, discharging and follow-up. ResultsTwelve patients were recovered and discharged from hospital with the New York Heart Association (NYHA) classification of heart function at class Ⅰ-Ⅱ. NYHA classification, grade of mitral regurgitation and regurgita- tion area were statistically improved on both the phase of discharge and follow-up compared with that of the pre-operation (P<0.05). Compared with preoperative left ventricular ejection fraction (LVEF), LVEF of discharging was statistically amelio- rative (P<0.05). And there was a statistic difference of NYHA classification of cardiac function in the phase of follow-up than that of discharging (P<0.05). ConclusionMitral valvuloplasty by chained double stitching without shaping ring is one reliable choice of treating IMR. The cardiac function and the living quality of the patients are statistically improved on the early stage and metaphase after operation, but long-term efficacy of this surgical procedure need be further assessed.
Mitral valvuloplasty is a more suitable surgical procedure than mitral valve replacement in the case of mitral valve degeneration. Quadrangular resection and artificial chordae plantation, considered to be classical procedures, are widely employed in posterior mitral valve prolapse, and have prominent long-term effects during the follow-up. However, is there any difference in mitral valve reconstruction due to completely different surgical methodology and concepts of the two procedures? Every surgeon has his own ideas and preferences for mitral valvuloplasty, and the choice of surgical procedures mostly depends on experience of surgeons. The article generally reviews variances in intraoperative and long-term clinical outcomes of both rectangular excision and artificial chordae plantation in posterior leaflet valvuloplasty, hoping to provide references for clinical decision.