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.
ObjectiveTo investigate the impact of graft type on perioperative outcomes and long-term prognosis in patients undergoing surgical repair of post-myocardial infarction ventricular septal rupture (VSR) with concomitant coronary artery bypass grafting (CABG). MethodsA retrospective analysis was conducted on clinical data from patients who underwent VSR repair and simultaneous CABG at Fuwai Hospital between 2005 and 2022. Patients were divided into an arterial graft group and a saphenous vein graft (SVG)-only group based on the type of bypass grafts used. Clinical outcomes were compared between the two groups. ResultsA total of 92 patients were included, comprising 56 males and 36 females, with a mean age of (62.4±7.9) years. The arterial graft group consisted of 60 patients, and the SVG-only group consisted of 32 patients. There were no statistical differences between the two groups in baseline characteristics, time interval from myocardial infarction to surgery, or culprit vessel distribution (P>0.05). A higher proportion of patients in the SVG-only group received preoperative intra-aortic balloon pump (IABP) support (56.3% vs. 35.0%, P=0.049). However, cardiopulmonary bypass time, aortic cross-clamp time, and early mortality rates were similar between the two groups (P>0.05). Follow-up data revealed no statistically significant differences in cumulative 10-year survival (82.8% vs. 80.0%, P=0.940) or freedom from major adverse cardiovascular and cerebrovascular events (MACCE) (49.6% vs. 58.6%, P=0.491) between the SVG-only and arterial graft groups. Furthermore, graft type did not significantly affect long-term mortality in patients with a culprit vessel in the left anterior descending artery or those with multivessel disease. ConclusionIn patients undergoing delayed repair of VSR with concomitant CABG, the use of arterial or saphenous vein grafts did not significantly impact perioperative outcomes or long-term prognosis. Future research should further explore the benefits of different revascularization strategies to optimize treatment for this population.
ObjectiveTo determine the clinical efficacy of transapical transcatheter mitral valve-in-valve treatment for patients with deteriorated mitral bioprosthesis after aortic-mitral double valve replacement.MethodsThe clinical data of 9 patients who underwent transapical transcatheter mitral valve-in-valve implantation after aortic-mitral double valve replacement due to mitral bioprosthesis deterioration from May 2020 to January 2021 in our hospital were retrospectively analyzed, including 4 males and 5 females with a mean age of 72.44±7.57 years.ResultsSurgeries were performed successfully in all patients with no conversion to median sternotomy. The mean procedural time was 101.33±48.49 min, the mechanical ventilation time was 23.11±26.54 h, the ICU stay was 1.89±1.05 d and the postoperative hospital stay was 6.11±2.02 d. Residual mild mitral regurgitation was only observed in 1 patient. Only 1 patient needed postoperative blood transfusion. No major complications were observed in all patients. There was no death in postoperative 90 days.ConclusionFor patients with deteriorated mitral bioprosthesis after aortic-mitral double valve replacement, transapical transcatheter mitral valve-in-valve implantation achieves good clinical results and effectively improves the hemodynamics without increasing the risk of postoperative left ventricular outflow tract obstruction. The surgery is feasible and effective.
ObjectiveTo investigate the effectiveness and safety of totally endoscopic transmitral myectomy (TETM) for hypertrophic obstructive cardiomyopathy (HOCM), comparing with traditional sternotomy modified Morrow procedure (SMMP).MethodsThirty-eight patients with HOCM who needed surgical intervention were selected from our hospital in 2019, including 14 males and 24 females, with an average age of 56 (44-68) years. According to the operation method, they were divided into a TETM group (n=18) and a SMMP group (n=20). Appropriate patients were screened by propensity matching scores. Finally, the clinical data of two matched groups were compared and analyzed.ResultsThere was no death, septal perforation, residual left ventricular outflow tract obstruction or third degree atrioventricular block in either group. After propensity score matching, there was no statistical difference between the two groups in the ICU length of stay (41.5±5.0 h vs. 53.0±24.0 h, P=0.620), ventilation time (19.5±9.2 h vs. 38.0±24.0 h, P=0.463), cardiopulmonary bypass time (190.7±45.6 min vs. 156.0±70.7 min, P=0.627), aortic cross-clamp time (100.1±25.3 min vs. 94.5±57.3 min, P =0.915), left ventricular outflow tract gradient (17.0±1.4 mm Hg vs. 5.0±0.5 mm Hg, P=0.053), left atrial anterior and posterior diameter (37.0±1.3 mm vs. 40.0±0.7 mm, P=0.090), interventricular septum thickness (12.5±0.7 mm vs. 13.0±1.4 mm, P=0.712), left ventricular posterior wall thickness (10.0±1.4 mm vs. 10.5±2.1 mm, P=0.811), left ventricular end-diastolic diameter (43.5±3.5 mm vs. 46.0±4.2 mm, P=0.589), and mitral regurgitation (1.0±0.2 vs. 0.7±0.5, P=0.500). The follow-up time was 6±3 months, and no death occurred. In the TETM group, one patient underwent mitral valvuloplasty again three months after surgery because of a tear in the A3 region of mitral valve..ConclusionTETM is a safe and effective procedure that can well expose the interventricular septum at the basal & middle obstruction site and effectively eliminate the mitral regurgitation associated with systolic anterior motion syndrome caused by left ventricular outflow tract obstruction.
An 81-year-old male patient was admitted to Guangdong Provincial People's Hospital due to chest distress and shortness of breath after activity for half a year. Examination after admission revealed severe aortic insufficiency, tricuspid aortic valve and extremely horizontal aorta with an aortic root angulation of 99°. The Society of Thoracic Surgeons score was 7%. And taking the strong demand of the patient and his family into consideration, we decided to perform transapical transcatheter aortic valve replacement after multidisciplinary evaluation. The procedure was successfully performed by means of low deployment land zone and traction of pre-exist Prolene suture. Three-month follow-up confirmed the normal function of aortic prosthetic valve without residual regurgitation. This case provides a reference for the interventional treatment in patients with extremely horizontal aorta.
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.