With the expanding indications for transcatheter aortic valve replacement (TAVR) guidelines, combined valvular disease is often encountered in the clinic, and existing relevant studies have shown that preoperative moderate to severe mitral regurgitation is associated with higher mortality. In these patients, the optimal treatment strategy for TAVR with evidence-based heart failure, TAVR with transcatheter mitral intervention, or staging transcatheter therapy are unclear. Therefore, a comprehensive assessment of the anatomy and function of the aortic and mitral valves, as well as an in-depth assessment of the patient’s baseline risk profile, are the basis for an individualized approach to treatment. This article will review the results of the relevant research to better help clinicians diagnose and treat relevant patients.
Objective To investigate the treatment and prognosis of moderate ischemic mitral regurgitation (IMR) in coronary artery disease(CAD). Methods From January 1998 to May 2006, 28 patients of CAD with moderate IMR underwent coronary artery bypass grafting (CABG) and mitral valve plasty(MVP, 24) or mitral valve replacement (MVR,4). The Reed method were used in 9 cases, the annuloplasty ring were used in 15 cases. Mechanical valve were implanted in 1 case and biological valve in 3 cases. Results There was no operative or hospital death. Twentysix patients were followed up to a mean period of 41 months. There were two late death(one was MVP, the other was MVR). In MVP cases, nineteen patients were in New York Heart Association (NYHA) functional class Ⅰ and Ⅱ, 3 in class Ⅲ, which was better than that of preoperative one. Ultrasonic cardiography (UCG) examination showed no mitral regurgitation in 5 cases, mild in 7, light in 6, moderate in 3, severe in 1. Left atrial volume (LAV) and left ventricular enddiastolic volume (LVEDV) were 54.1±12.7ml and 60.9±14.8 ml, decreased more significantly than that preoperatively (Plt;0.05). In MVR cases, 2 cases were survival and followed. One patient was in NYHA functional class Ⅰ, 1 in class Ⅱ, which was better than that of preoperative one. Conclusion Moderate IMR with CAD should be treated carefully. MVP with annuloplasty ring have better early results. For patients with bad heart function and abnormal left ventricular wall motion, the late results need more studies.
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 short-and long-term results of mitral valve repair for the treatment for mitral anterior leaflet prolapse (ALP), and summarize our clinical experience. MethodsClinical data of 67 patients with mitral ALP who underwent mitral valve repair in Department of Cardiac Surgery of Beijing Anzhen Hospital from January 2002 to June 2013 were retrospectively analyzed. There were 41 male and 26 female patients with their age of 18-71 (46.34±7.68)years and body weight of 43-91 (65.30±18.60)kg. Preoperatively, there were 5 patients in New York Heart Association (NYHA)function class Ⅱ, 27 patients in class Ⅲ, and 35 patients in class Ⅳ. Surgical techniques included 'edge-to-edge' technique, artificial chordal replacement, chordal shortening and edge-to-edge chordal transformation. There were 46 patients with chordal rupture and 21 patients with chordal elongation. Mean mitral regurgitation (MR)area was 15.36±4.53 cm2, and left ventricular ejection fraction (LVEF)was 29%-71%. Echocardiography was performed before discharge, 6 months and every 1 to 2 years after the operation for all the patients to observe short-and long-term results of mitral valve repair for the treatment for mitral ALP. ResultsThere was no in-hospital death. One patient underwent mitral valve replacement because of anterior leaflet perforation 3 days after the operation. Another patient underwent a second mitral valve repair because of avulsion of mitral annulus and proteinuria 6 months after the first operation. None of the other patients received reoperation. All the 67 patients (100%)were followed up for 2-138 (65.6±17.3)months. During follow-up, there was not late death, and all the patients were in NYHA functional class I. Echocardiography showed that cross-sectional area of the mitral valve was 2.3-4.8 (3.63±0.79)cm2. There was no significant MR, and mean MR area was 0.57±0.37 cm2. Left atrium diameter (38.23±11.56 mm vs. 49.26±10.36 mm, P < 0.05)and left ventricular end-diastolic diameter (43.35±13.74 mm vs. 64.29±12.54 mm, P < 0.05)were significantly smaller than preoperative values. ConclusionNearly all the patients with mitral ALP can receive personalized mitral valve repair with satisfactory surgical outcomes.
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．
ObjectiveTo compare the clinical outcomes of mitral valvuloplasty (MVP) and mitral valve replacement (MVR) for infective endocarditis, and to investigate the effect of MVP under different surgical risks. MethodsA retrospective study was done on the patients with mitral infective endocarditis, who underwent surgical treatment in our department from January 2018 to March 2022. According to the procedures, the patients were divided into a MVP group and a MVR group. Propensity score matching method was applied with a ratio of 1:1 to eliminate the biases. The early and midterm outcomes were compared between the two groups after matching. According to the European System for Cardiac Operative Risk Evaluation Ⅱ(EuroSCORE-Ⅱ), the effect of MVP was compared between high and low risk patients. ResultsA total of 195 patients were collected. There were 141 patients in the MVP group (120 males, 85.1%) and 54 patients in the MVR group (41 males, 75.9%). The mean follow-up time was (34.0±16.1) months. Patients in the MVP group were younger [(42.7±14.6) years vs. (56.8±13.0) years, P<0.001] and had better preoperative conditions. The patients in the MVP group had a shorter ICU stay [3.0 (2.0, 5.0) d vs. 4.0 (3.0, 8.0) d, P=0.004], and lower incidences of low cardiac output syndrome (0.7% vs. 9.3%, P=0.007), in-hospital mortality (0.0% vs. 3.7%, P=0.023), and follow-up mortality (4.3% vs. 15.4%, P=0.007). However, after 1:1 propensity score matching, there were no statistical differences in the baseline data or postoperative and follow-up adverse events between the two groups (P>0.05). Also, there was no statistical difference in the mortality of high-risk patients between MVP and MVR group (P>0.05). There was no statistical difference in the reoperation or recurrent severe mitral regurgitation between high and low-risk patients in the MVP group (P>0.05). Conclusion MVP is feasible for treating mitral lesions caused by infective endocarditis with good early and midterm outcomes. For patients with severer preoperative conditions, if the leaflet damage is not severe, MVP may be a viable option, but validation with larger sample sizes is needed.
Objective To investigate the effect of edgetoedge mitral valve plasty on left ventricular diastolic function and in order to find the validity and safety of this procedure. Methods From Feb. 2006 to Dec. 2007, thirty cases with mitral regurgitation were divided into two groups. Quadrangular resection was performed on fifteen cases with posterior proplapse in control group, and edgetoedge mitral valve plasty was performed on fifteen cases with anterior or bileaflet proplapse in experimental group, and ring annuloplasty(Medtronic ring) was used in both groups. The hemodynamics were monitored and recorded with SwanGanz catheter at the time of postoperation，2 h, 4 h, 6 h and 12 h after operation. Left ventricular diastolic function was also evaluated with echocardiography using color Doppler and tissue Doppler imaging in the patients with sinus rhythm. The ratio of the peak E velocity and A velocity(E/A), the ratio of the early diastolic peak flow velocity to the early diastolic mitral valve annular movement velocity(E/Em), and the ratio of early diastolic mitral valve annular movement velocity to late diastolic mitral valve annular movement velocity（Em/Am）were measured before operation and 1 week after operation respectively. Results Mitralvalve area were significantly reduced at 1 week after operation compared with that before operation in both groups (control group 3.63±1.06 cm2 vs. 7.18±2.41 cm2, experimental group 3.44±1.02 cm2 vs. 6.51±3.06 cm2, Plt;0.05）; and mitral regurgitant grade were significantly reduced at 1 week after operation in both groups as well(control group 0.53±0.64 cm2 vs.3.60±0.51 cm2, experimental group 0.67±0.82 cm2 vs.3.40±0.63 cm2, Plt;0.05). However, there was no significant difference for mitral valve area and mitral regurgitant grade between two groups before and after operation（Pgt;0.05）. In experimental group, there were no significant change of evaluations of E/A,E/Em and Em/Am before and after operation（E/A 1.28±0.36 vs. 1.95±1.06,E/Em 8.79±2.16 vs. 8.13±3.02, Em/Am 1.39±0.38 vs. 1.31±041，Pgt;0.05). There was no significant change of pulmonary artery wedge pressure (PAWP) before and after operation between two groups（13.60±4.37 mm Hg vs.12.20±3.53 mm Hg, Pgt;0.05）. Conclusion Edgetoedge mitral valve plasty technique is available and has no significant influence on left ventricular diastolic function, and a doubleorifice mitral valve has similar hemodynamic change compared with a physiological mitral valve.