ObjectiveTo compare the safety and clinical outcomes of isolated aortic valve replacement (AVR)through right anterior minithoracotomy (RAMT)and conventional median sternotomy. MethodsFrom March 2006 to March 2013, 169 patients underwent isolated AVR in Department of Cardiothoracic Surgery, Xinhua Hospital, Shanghai Jiaotong University School of Medicine. Among them, 42 patients received AVR via RAMT (RAMT group)including 30 males and 12 females with their age of 59.31±8.30 years. And 127 patients received AVR via conventional median sternotomy (conventional surgery group)including 89 males and 38 females with their age of 60.02±5.93 years. There were 75 patients with aortic valve stenosis (AS), 42 patients with aortic regurgitation (AR)and 52 patients with AS+AR. Postoperative outcomes were compared between the 2 groups. ResultsThere was no statistical difference in preoperative clinical characteristics between the 2 groups. All the patients successfully received isolated AVR. 153 patients received mechanical prosthesis and 16 patients received bioprosthetic valves. Fifty-two patients received 21 mm valves, and 117 patients received 23 mm valves. Cardiopulmonary bypass time and aortic cross-clamping time of RAMT group were significantly longer than those of conventional surgery group (P < 0.001). But mechanical ventilation time, length of postoperative ICU stay and hospital stay of RAMT group were significantly shorter than those of conventional surgery group (P < 0.001). Postoperative thoracic drainage, intraoperative and postoperative blood transfusion of RAMT group were significantly less than those of conventional surgery group (P < 0.001). In conventional surgery group, 2 patients underwent reexploration for bleeding and 2 patients had wound infection postoperatively. Two patients died postoperatively, both in conventional surgery group, including 1 patient with low cardiac output syndrome and multiple organ dysfunction syndrome, and another patient with prosthetic valve endocarditis secondary to sternal wound infection. ConclusionCompared with conventional median sternotomy, RAMT is safe and efficacious for patients undergoing isolated AVR with minimal surgical injury, better postoperative recovery and cosmetic outcomes.
Objective To observe preserving effect on myocytes in porcine aortic valve replacement with minimal extracorporeal circulation (MECC). Methods 7 pigs were collected as experimental animals and undertook aortic valve replacement with MECC. Morphological and immunofluorescence intensity changes of right atrial and left ventricular tissues were observed. Results HE staining showed that there were not significant changes and edema or injury of myocytes of right atriums and left ventricles between preoperation and postoperation. Immunofluorescence staining showed complement C3b/c in right atrial myocardial tissues after the operation were a little ber, and innate antibody IgG were a little ber in left ventricular myocardial tissues but similarly weak in right atrial myocardial tissues pre- and post-operation. There was not significant changes in HSPG staining in pre-and post-operative right atrial myocardial tissues, but HSPG were obviously weaker in left ventricular myocardial tissues after the operation. Conclusion MECC is effective on support of porcine aorta valve replacement.
Nowadays, aortic bioprostheses are used more and more widely in clinical practice, but the valve will experience structural valve degradation over time, and eventually lose its function, which is valve failure. Valve failure has become a significant challenge for aortic valve replacement and especially limits the expansion of indications for transcatheter aortic valve replacement. This review focuses on the current status and relevant evidence on the definition, risk factors, epidemiological characteristics, diagnosis and evaluation, treatment strategies of aortic bioprostheses failure. The purpose is to provide a basis for a more comprehensive understanding of aortic bioprostheses failure, finding better coping strategies and further improving the long-term durability of the valve.
ObjectiveTo analyze the safety and effectiveness of minimally invasive small incision through the right third intercostal and standard aortic valve replacement.MethodsThe clinical data of 123 patients with the first simple aortic valve replacement in our hospital from June 2013 to May 2020 were retrospectively analyzed. The patients receiving aortic valve replacement through the right third intercostal small incision were allocated to a minimally invasive group, and patients receiving aortic valve replacement through the median sternal incision were allocated to a common group. The clinical outcomes of the two groups were compared.ResultsThere were 40 patients in the minimally invasive group, including 11 (27.5%) females and 29 (72.5%) males, aged 54.60±9.98 years with the body mass index (BMI) of 23.16±2.48 kg/m2. There were 83 patients in the common group, including 27 (32.5%) females, 56 (67.5%) males, aged 58.77±9.71 years, with the BMI of 24.13±3.13 kg/m2. Compared with the common group, the aortic cross-clamping time, cardiopulmonary bypass time, and operation time were longer (P<0.05), the ventilator support time was shorter (P<0.05), and the blood loss, postoperative 24 h chest drainage volume and total expense were less (P<0.05) in the minimally invasive group. The ICU stay, postoperative hospital stay, and total hospital stay were not statistically different between the two groups (P>0.05).ConclusionThe aortic valve replacement through the right third intercostal small incision is safe and effective, with less blood loss, 24 h chest drainage volume and invasiveness.
ObjectiveTo assess early and mid-term outcomes and our clinical experience of reduction ascending aortoplasty (RAA) for patients with aortic valve disease and ascending aortic dilatation, and improve treatment effects. MethodsClinical data of 36 patients with aortic valve disease and ascending aortic dilatation who underwent aortic valve replacement and RAA in Fu Wai Hospital between January 2002 and August 2010 were retrospectively analyzed. There were 26 male and 10 female patients with their age of 7-72 (51±16) years. Ascending aorta diameter (AAD) was measured by echocardiography preoperatively, postoperatively, during follow-up and compared. ResultsThere was no perioperative death. Cardiopulmonary bypass time was 96.2±28.3 minutes, and aortic cross-clamp time was 69.2±22.1 minutes. Posto-perative hospital stay was 11.0±7.8 days. All the 36 patients were followed up after discharge for 1.1-9.0 (4.0±2.3) years. During follow-up, there was 1 death, but none of the patients needed reoperation. Echocardiography showed normal aortic valve function. Postoperative AAD was significantly smaller than preoperative AAD (36.4±6.1 mm vs. 46.8±4.6 mm, t=13.12, P=0.00). AAD during follow-up was significantly larger than postoperative AAD (40.8±6.8 mm vs. 36.4±6.1 mm, t=-2.64, P=0.01) but significantly smaller than preoperative AAD (40.8±6.8 mm vs. 46.8±4.6 mm, t=3.48, P=0.00). ConclusionEarly and mid-term outcomes of RAA are satisfactory for patients with aortic valve disease and ascending aortic dilatation, but long-term results need further observation.
Abstract：?Objective?To analyze surgical procedures and clinical outcomes for patients with hypertrophic obstructive cardiomyopathy （HOCM） complicated by infective endocarditis.?Methods?We retrospectively analyzed clinical data of 7 patients with HOCM complicated by infective endocarditis who underwent modified Morrow procedure，removal of intracardiac vegetation，and valve replacement in Fu Wai Hospital from Sep. 2006 to Feb. 2012. There were 5 male patients and 2 female patients with their mean age of 39.80±13.60 years（ranging 21-55）. Postoperative clinical outcomes were observed. Preoperative and postoperative left ventricular outflow tract （LVOT） gradients， left atrium （LA） diameter，left ventricular ejection fraction （LVEF） and heart function were compared.?Results?There was no in-hospital death and perioperative survival rate was 100% in this group. Bacteria vegetations were multiply detected on the mitral valve leaflet （7 cases）， aortic valve leaflet （4 cases） and ventricular septum （1 case） with their diameter of 2-19 mm. Blood culture showed Staphylococcus aureus （3 cases），Squirrel aureus （1 case） . Postoperatively， first-degree atrioventricular block occurred in 2 patients， complete left bundle branch block in 1 patient， left anterior division block in 2 patients， and all these complications were not treated. Postoperative LVOT gradient and LA diameter were significantly lower than preoperative values （P＜0.05）， and cardiac function was significantly improved in these patients. All the patients underwent transthoracic echocardiography at a mean follow-up of 13.00±17.19 （1-49） months in outpatient service. The clinical symptoms of all these patients were diminished or significantly ameliorated and their quality of life was considerably improved. All the patients had NYHA classⅠorⅡ without any reintervention or death during follow-up.?Conclusion?Modified Morrow procedure and valve replacement is a good surgical strategy for patients with HOCM complicated by infective endocarditis with satisfactory early and mid-term clinical outcomes.
Abstract： Objective To investigate the effects of βreceptor blocker on intraventricular pressure gradient and left ventricle remodeling after valve replacement for critical aortic stenosis. Methods Fifty-six patients with critical aortic stenosis underwent aortic valve replacement surgery from January 2008 to January 2010 in the First Affiliated Hospital of Zhengzhou University. Thirtytwo of them who were followed up were selected to be enrolled in this study. The patients were divided into two groups under the same basis of clinical features. Twelve patients in the experimental group received oral βreceptor blocker (Metoprolol, 6.2525.00 mg once, twice daily). The rest 20 patients in the control group had no βreceptor blocker. The various indicators of ultrasound cardiogram (UCG) shortly after operation (within a week) and long after operation (6-24 months) were compared between the two groups. Results No death occurred in both groups, and chest distress, shortness of breath and other symptoms were obviously alleviated. Although left ventricular endsystolic dimension (LVESD) and left ventricular outflow tract dimension (LVOTD) of both groups increased 6-24 months after operation, compared with the early postoperative period, only the increase of LVOTD in the experimental group showed statistical difference (t=-47.937, P=0.001). In both groups, interventricular septum thickness (IVST), left ventricular posterior wall thickness (LVPWT), filament band velocity of left ventricular outflow tract (V), intraventricular pressure gradient (G) and left ventricular mass index (LVMI) of the later period after operation were significantly lower than those of the early postoperative period. All these indicators in the experimental group showed significant differences (t=7.781, P=0.001；t=5.749, P=0.001; t=2.637, P=0.023; t=7.167, P=0.001; t=100.061, P0.001), while only V, G， and LVMI showed statistical differences in the control group (t=4.051, P=0.001; t= 4.759, P= 0.001; t=-0.166,P=0.001). EF in the experimental group also indicated significant difference compared with early period after aortic valve replacement (t=-6.621, P=0.001). EF between two groups indicated no significant difference (t=-0.354,P=0.726). But differences between the two groups in LVEDD, IVS, G， and LVMI were all statistically significant in the later period after surgery (t=-2.494, P=0.018; t=-3.434, P=0.002;t=-2.171,P=0.038; t=-2.316, P=0.028). Conclusion β-receptor blocker is a safe and reliable drug for those patients who have undergone aortic valve replacement surgery for critical aortic stenosis, and can decrease significantly the residual intraventricular pressure gradient and accelerate left ventricular cardiac remodeling.
ObjectiveTo assess mid- and long-term outcomes of ascending aortic wrapping (AAW) in adult patients undergoing aortic valve replacement (AVR). MethodsWe retrospectively analyzed clinical data of adult patients who underwent AVR and AAW in Fuwai Hospital from January 2010 to August 2019. Ascending aorta diameter (AAD) was measured by echocardiography or CT scan preoperatively and postoperatively. ResultsA total of 33 patients were enrolled, including 23 males and 10 females aged 22-73 (51.06±12.61) years. There was no perioperative death. The mean preoperative, postoperative and follow-up AAD of the patients were (46.06±3.54) mm, (34.55±5.17) mm, and (37.12±5.64) mm, respectively. The differences in the AAD between pre-operation and post-operation, and between pre-operation and the last follow-up were both statistically significant (P<0.05). The median follow-up time was 38.20 (18.80-140.30) months. The median increase rate of diameter was 0.63 (−0.11, 1.36) mm per year after the surgery. The increase rate was >5 mm per year in 1 patient, and >3 mm in another one. ConclusionThe mid- and long-term outcomes of AAW in adult patients undergoing AVR are satisfactory and encouraging.
Heart valve replacement is the major surgical treatment of severe valvular diseases. Due to the durability and reoperation-free, mechanical valves are widely used. Bioprosthesis valves became popular recently because of long service life and no demand for lifelong anticoagulation. However, how to choose the appropriate prosthetic heart valves, especially the application of bioprosthesis valves for patients at 55 to 65 years is still a major problem. This review focuses on more effective and scientific basis for rational choice of mechanical and bioprosthesis valve.
ObjectiveTo analyze long-term outcomes of aortic valve replacement (AVR) for patients with severe aortic regurgitation (AR) and left ventricular dysfunction (LVD). MethodsWe retrospectively analyzed clinical data of 44 patients with severe AR and LVD who received AVR in Drum Tower Hospital from January 2002 to December 2012. Left ventricular ejection fraction (LVEF) of all the patients was lower than 35%. There were 29 male and 15 female patients with their age of 23-78 (44±6) years and LVEF of 22%-34% (29%±3%). ResultsTwo patients died because of heart failure postoperatively. Cardiopulmonary bypass time was 57-92 (73±8) minutes, aortic cross-clamping time was 33-61 (48±6)minutes, and length of ICU stay was 2-15 (8±3) days. All the patients were followed up for 1-11 (4.3±2.9) years. Two patients died during follow-up because of heart failure and stroke respectively. One-year survival rate was 93% and five-year survival rate was 91%. ConclusionAVR can significantly increase long-time survival of patients with severe AR and LVD.