Abstract： Objective To evaluate the early and late results of mitral valve replacement with home made C-L pugesturt tilting disc and analyse the factors which impact on the therapeutic effect，so as to elevate the operative effect. Methods A retrospective study was made on the result of clinical data and longterm followup of 259 patients who had undergone the Chinesemade C-L pugesturt tilting disc mechanical valve replacement from October 1991 to November 2006. Results The data showed that there were 12 patients died in the duration of hospital stay.The hospital mortality was 4.63% (12/259).There were no mechanical valverelated complication in the earlier postoperative period.The mortality fell to 2.59% since 1996.Among the 235 patients,12 patients were lost during the followup,the rate of followup was 95.1%(235/247).The time for followup was 9.77±3.09 years. There were 26 late deaths.During the follow-up,death associated with the deterioration of valve structure were not observed. The 5 years, 10 years and l5 years survival rates were 86.80%±2.30%, 78.20%±3.33% and 55.23%±4.34% respectively; the thromboembolic event free rates for 5 years, 10 years and l5 years were 95.95%±0.74%, 92.52%±4.11% and 80.52%±4.11% respectively; the anticoagulant related bleeding free rates for 5 years, 10 years and l5 years were 94.64%±1.75%, 89.55%±3.28% and 79.39%±4.43% respectively.There were 141 patients(67.46%) in New York Heart Association(NYHA) classⅠ, 56 patients(26.79%) in class Ⅱ, 10 patients(4.78%) in class Ⅲ and 2 patients(0.95%) in class Ⅳ. Conclusion The results of follow-up for 15 years suggest that the Chinesemade C-L pugesturt tilting disc medical mechanical valve is a reliable and safe choice for mitral valve replacement.
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.
Abstract： Objective To summarize our experience and clinical outcomes of preservation of posterior leaflet and subvalvular structures in mitral valve replacement（MVR）. Methods We retrospectively analyzed the clinical data of 1 035 patients who underwent MVR in Beijing An Zhen Hospital from January 2006 to March 2011. There were 562 male patients and 473 female patients with their age of 37-78（53.84±13.13）years old. There were 712 patients with rheumatic valvular heart disease and 323 patients with degenerative valve disease, 389 patients with mitral stenosis and 646 patients with mitral regurgitation. No patient had coronary artery disease in this group. For 457 patients in non-preservation group, bothleaflets and corresponding chordal excision was performed, while for 578 patients in preservation group, posterior leafletand subvalvular structures were preserved. There was no statistical difference in demographic and preoperative clinical characteristics between the two groups. Postoperative mortality and morbidity, and left ventricular size and function were compared between the two groups. Results There was no statistical difference in postoperative mortality（2.63% vs. 1.21%, P =0.091）and morbidity （8.53% vs. 7.44%, P=0.519）between the non-preservation group and preservation group, except that the rate of left ventricular rupture of non-preservation group was significantly higher than that of preservation group（1.09% vs. 0.00%, P=0.012）. The average left ventricular end-diastolic dimension （LVEDD）measured by echocardiography 6 months after surgery decreased in both groups, but there was no statistical difference between the two groups. The average left ventricular ejection fraction (LVEF) 6 months after surgery was significantly improved compared with preoperative average LVEF in both groups. The average LVEF 6 months after surgery in patients with mitral regurgitation in the preservation group was significantly higher than that in non-preservation group （56.00%±3.47% vs. 53.00%±3.13%，P =0.000）, and there was no statistical difference in the average LVEF 6 months after surgery in patients with mitral stenosis between the two groups（57.00%±5.58% vs. 56.00%±4.79%，P =0.066）. Conclusion Preservation of posterior leaflet and subvalvular structures in MVR is a safe and effective surgical technique to reduce the risk of left ventricle rupture and improve postoperative left ventricular function．
Reoperation due to degenerated bioprostheses is an important factor of high-risk thoracic surgeries. In 2020 ACC/AHA guideline, Valve in Valve (ViV) was recommended for high-risk patient instead of surgical mitral valve replacement. This report described a 77-year-old male patient with a failed mitral bioprosthetic valve, evaluated at high risk of surgery, received a transvenous, transseptal transcatheter mitral valve replacement (TMVR). Tracheal intubation was removed at CCU 3 h after surgery without discomfort such as polypnea. The patient was transferred out of the CCU and discharged on the 3rd day. Compared with transapical access, transvenous transseptal access was less invasive, with shorter duration in CCU and hospitalization.
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 summarize the experiences of radiofrequency modified maze procedure for atrial fibrillation (AF) in patients with mitral valve diseases. Methods From May 2003 to December 2008, 122 patients, including 31 males and 91 females, with permanent AF underwent radiofrequency modified maze procedure as a combined operation with mitral valve replacement. Their age ranged from 23 to 65 years old (47±10 years). The duration of AF varied from 0.5 to 32.0 years (6.5±5.7 years). There were 57 cases of stenosis, 7 cases of regurgitation and 58 cases of both stenosis and regurgitation. Ablation lines were made with Cardioblate (Medtronic, monopolar, 25.30 W, 180.240 ml/h). After rightsided maze procedure was finished, aorta was crossclamped and cold crystalloid or blood cardioplegia were delivered for myocardial protection. Left atrial incision was performed through the interatrial groove or interatrial septum. The ablation lines were created to encircle the orifices of the left and right pulmonary veins respectively. The ablation lines were also performed from the left encircling line to the posterior mitral valve annulus and to the orifice of left atrial appendage respectively. An ablation line was used to connect the circumferential line of left and right pulmonary veins. The left atrial appendage was tied and concomitant operations were performed. Amiodarone was given to the patients after operation and regular follow-up was done. Results There were four perioperative deaths including 2 cases of multiple organ failure, 1 case of mechanic valve obstruction and 1 sudden death. Follow-up was done to 115 patients for 1.5-7.0 years (4.8±2.6 years) with three cases lost. During the followup period, four patients died, including 3 sudden deaths and 1 case of prosthetic obstruction. Eightyseven patients (78.4%, 87/111) recovered to sinus rhythm; 22 patients still had AF; 1 patient had atrial flutter; and 1 patient required a permanent pacemaker one year after the operation. Diameter of left atrium after operation (0.5-7.0 years) was decreased compared with that before operation（44.90±7.50 mm vs. 54.30±10.80 mm，t＝10.641，P＝0.000）. Conclution Radiofrequency modified maze procedure for AF in patients with mitral valve disease is relatively safe. But heart rhythm instability, tachyarrhythmia and recurrent AF are not rare for those patients. Therefore, the surgical indication of AF should be individualized.
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.
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.
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.
Objective To evaluate long-term clinical results in patients who underwent mitral valve replacement and suture tricuspid annuloplasty. Methods We included 401 patients who underwent mitral valve replacement and suture tricuspid annuloplasty in our hospital between January 2006 and March 2011. There were 309 females and 92 males at age of 17-71 (46.2±12.0) years. All patients were investigated by echocardiography at postoperative 5 years. The tricuspid valve procedures consisted of bicuspidization, modified Kay annuloplasty and leaflet repair according to the actual conditions. Results The patients were followed up for 5–10 (7.4±1.4) years. As compared with preoperation, the right atrium (RA, 7.6±13.0 mm vs. 49.3±13.2 mm), right ventrium (RV, 23.2±4.7 mm vs. 22.0±3.6 mm), left atrium (LA, 59.7±19.0 mm vs. 53.6±14.7 mm, left ventrium (LV, 49.3±8.6 mm vs. 47.7±6.2 mm), tricuspid of end-distolic diameters (TEDD, 35.9±5.7 mm vs. 32.8±5.9 mm) and tricuspid of end-systolic diameters (TESD, 9.4±5.7 mm vs. 26.5±4.9 mm) of patients decreased significantly at postoperation (P<0.01). As compared with preoperation, left ventricular ejection fraction (LVEF, 60.3%±8.9% vs. 61.7%±8.3%) and left ventricular fractional shortening (LVFS, 32.6%±6.3% vs. 33.8%±5.5%) raised significantly at postoperation (P<0.01). As compared with preoperation, the constituent rate of tricuspid regurgitation (TR) improved significantly at postoperation (P<0.01). Conclusion Tricuspid annuloplasty adopting TEDD as a surgical indication is reasonable for patients with mitral diseases. Combined and individualized suture tricuspid annuloplasty can obtain better long-term results. It is needed to order aggressive diuretics treatment for patients with postoperative TR.