ObjectiveTo research the procedure for creating an animal model of mitral regurgitation by implanting a device through the apical artificial chordae tendineae, and to assess the stability and dependability of the device. MethodsTwelve large white swines were employed in the experiments. Through a tiny hole in the apex of the heart, the artificial chordae tendineae of the mitral valve was inserted under the guidance of transcardiac ultrasonography. Before, immediately after, and one and three months after surgery, cardiac ultrasonography signs were noted. Results All models were successfully established. During the operation and the follow-up, no swines died. Immediately after surgery, the mitral valve experienced moderate regurgitation. Compared with preoperation, there was a variable increase in the amount of regurgitation and the values of heart diameters at a 3-month follow-up (P<0.05). ConclusionIn off-pump, the technique of pulling the mitral valve leaflets with chordae tendineae implanted transapically under ultrasound guidance can stably and consistently create an animal model of mitral regurgitation.
ObjectiveTo evaluate the safety and efficacy of transapical mitral valve repair with moderate-to-severe or severe mitral regurgitation (MR) by using LifeClip system. Methods We retrospectively analyzed the clinical data of 7 symptomatic patients with moderate-to-severe or severe MR who received transapical mitral valve repair by using the LifeClip system in our hospital from July to November 2021. There were 5 males and 2 females with an average age of 76.0±7.5 years. ResultsThere were 2 patients with degenerative MR and 5 patients with functional MR. All of the procedures were successful and 6 patients received 1 LifeClip while the other one patient received 2. The operation time was 135.7±46.9 min, the mechanical ventilation time was 12 (3, 14) h, and the hospital stay time was 18.1±4.1 d. No serious complications or death occurred during the perioperative or follow-up period. MR reduction by ≥2 grades was achieved in all the patients at the one-month follow-up. The classification of cardiac function was improved in varying degrees. Conclusion Transapical mitral valve repair using the LifeClip system shows good safety and efficacy for severe MR patients, and MR degree is significantly improved at early follow-up. However, the benefit of LifeClip should be validated in a larger sample size of Chinese population and through long-term follow-up.
ObjectiveTo systematically evaluate the differences in efficacy and outcomes between patients with functional mitral regurgitation (SMR) and degenerative mitral regurgitation (DMR) treated with mitral edge-to-edge repair (TEER) using MitraClip. MethodsPubMed, EMbase, the Cochrane Library, Web of Science, China Biomedical Literature Database (CBM), CNKI, Wanfang database, and VIP database were searched in computer. Relevant literature from the database from its establishment to January 2024 was covered. Literature screening, data extraction, and risk of bias assessment for the included studies were performed independently by two researchers. Meta-analysis was performed using Stata18.0 software. ResultsFourteen papers were finally included, including 6 707 patients, including 4 161 patients in the SMR group and 2 241 patients in the DMR group. Meta-analysis results showed that patients in the SMR group had a higher 1-year all-cause mortality rate [OR=1.53, 95%CI (1.30, 1.81), P<0.01, I2=0%] and 1-year readmission rate for heart failure [OR=1.9, 95%CI (1.60, 2.26), P<0.01, I2=0%] after MitraClip treatment than the DMR group patients. Postoperative mitral transvalvular pressure difference [SMD=-0.47, 95%CI (-0.65, -0.30), P<0.01, I2=51%] was lower in patients in the SMR group than in those in the DMR group, and the incidence of subsequent secondary open-heart surgery [OR=0.41, 95%CI (0.20, 0.83), P=0.01, I2=0%] was lower in patients in the SMR group. ConclusionThe results of Meta-analysis showed that after MitraClip treatment, patients in the SMR group showed better efficacy in the short term, but the medium- and long-term efficacy was not as good as that of patients in the DMR group. The specific type of mitral regurgitation should be considered when choosing a MitraClip treatment strategy to more accurately predict efficacy and prognosis.
Mitral regurgitation (MR) is the most common heart valve disease. In recent years, the rise of interventional therapy has expanded the indications of interventional treatment for patients with MR, but the epidemiological characteristics of MR (especially the number of patients with MR requiring treatment) in China are still unclear. In this paper, we analyzed and estimated the number of MR patients in China based on three epidemiological studies in Europe and America, and referring to the patients population surveys from Zhongshan Hospital Affiliated to Fudan University, the Second Affiliated Hospital Zhejiang University School of Medicine and Beijing Fuwai Hospital. Our analysis estimated that about 7.5 million patients with MR need intervention in China, including about 5.5 million patients with severe MR.
Objective To investigate the changing tendency of mitral valve coaptation area and coaptation index of moderate mitral regurgitation （MR） in a dog experiment，and provide evidence for predicting long-term surgical results. Methods Real-time three-dimensional transesophogeal echocardiography （RT-3D-TEE） images were obtained in 15 dogs via Philips IE33 echocardiography system，and animal experiment model was established. RT-3D-TEE images were taken by gradually narrowing the ascending aorta and increasing left ventricular pressure till moderate MR. Original data were analyzed using Philips Qlab 7.0 three-dimensional quantification software，and mitral valve coaptation area and coaptation index were calculated. Specimen coaptation index of the mitral leaflets was calculated after the animal experiment. Cutoff values of coaptation index and left ventricular pressure were calculated by receiver operating characteristic （ROC） curve. Results There was statistical difference in coaptation area （198±50）mm2 vs. （123±36）mm2，P＜0.05） and coaptationindex （0.25±0.06 vs. 0.13±0.03，P＜0.05） between non-MR state and MR status of the 15 dogs. The area under the ROC curve of coaptation index and moderate MR was 0.879±0.019 with 95% CI 0.843 to 0.916，and the cutoff value was 0.213（P＜0.05）. The area under the ROC curve of left ventricular pressure and moderate MR was 0.882±0.021 swith 95% CI 0.840 to 0.923，and the cutoff value was 225 （P＜0.05）. There was no statistical difference between specimen mitral valve area and early-diastolic mitral leaflet area，specimen coaptation area and coaptation area，specimen coaptation index and coaptation index （P＞0.05）. Early-diastolic mitral leaflet area was significantly correlated with specimen mitral valve area （r=0.937，P＜0.05）. Coaptation area was significantly correlated with specimen coaptation area （r=0.917，P＜0.05）. Coaptation index was significantly correlated with specimen coaptation index （r=0.946，P＜0.05）. The correlation of coaptation index and specimen coaptation index was higher than those of coaptation area and specimen coaptation area，and earlydiastolic mitral leaflet area and specimen mitral valve area. Conclusions Both coaptation area and coaptation index significantly decrease in MR status. Coaptation index can more precisely reflect MR degree，and provide reference for prognosis of mitral valve repair. RT-3D TEE can accurately measure mitral valve coaptation area and coaptation index.
Objective To compare the effect of palliative mitral valve surgeries and medication therapies for secondary non-ischemic mitral regurgitation. Methods The clinical data of patients with non-ischemic functional mitral regurgitation treated in our hospital between 2009 and 2019 were retrospectively analyzed. Patients with a left ventricular ejection fraction (LVEF)＜40% underwent a dobutamine stress test, and a positive result was determined when the LVEF improved by more than 15% compared to the baseline value. Positive patients were divided into a surgery group and a medication group. The surgery group underwent surgical mitral valve repair or replacement, while the medication group received simple medication treatment. Follow-up on survival and cardiac function status through outpatient or telephone visits every six months after surgery, and patients underwent cardiac ultrasound examination one year after surgery. The main research endpoint was a composite endpoint of all-cause death, heart failure readmission, and heart transplantation, and the differences in cardiac function and cardiac ultrasound parameters between the two groups were compared. ResultsUltimately 41 patients were collected, including 28 males and 13 females with an average age of 55.5±11.1 years. Twenty-five patients were in the surgery group and sixteen patients in the medication group. The median follow-up time was 16 months, ranging 1-96 months. The occurrence of all-cause death in the surgery group was lower than that in the medication group (HR=0.124, 95%CI 0.024-0.641, P=0.034). The difference between the two groups was not statistically significant in the composite endpoint (HR=0.499, 95%CI 0.523-1.631, P=0.229). The New York Heart Association (NYHA) grade of the surgery group was better (NYHA Ⅰ-Ⅱ accounted for 68.0% in the surgury group and 18.8% in the medication group, P<0.01) as well as the grade of mitral valve regurgitation (87.5% of the patients in the medication group had moderate or above regurgitation at follow-up, while all the patients in the surgery group had moderate below regurgitation, P<0.01). There was no statistical difference in preoperative and follow-up changes in echocardiograph parameters between the two groups (P＞0.05). Conclusion For non-ischemic functional mitral regurgitation, if the cardiac systolic function is well reserved, mitral valve surgery can improve survival and quality of life compare to simple medication therapy.
Transcatheter edge-to-edge repair (TEER) for mitral regurgitation (MR) is known as M-TEER. Its strengths include: precise targets and fewer implants; simple and clear principles for catheterization; originating from dependable medical concepts and broad applicability. Furthermore, TEER offers advantages in real-time hemodynamic and effectiveness measurement throughout the procedure over surgical edge-to-edge repair (SEER). When it comes to patients with degenerative mitral regurgitation , M-TEER should aim to deliver more optimum procedural outcomes. In functional mitral regurgitation, a modest transvalvular gradients or moderate residual shunt can be tolerated with M-TEER, which reduces the risk of problems and has no bearing on the patient's prognosis.
ObjectiveTo examine the safety, efficacy and durability of totally endoscopic minimally invasive (TEMI) mitral valve repair in Barlow’s disease (BD). MethodsA retrospective study was performed on patients who underwent mitral valve repair for BD from January 2010 to June 2021 in the Guangdong Provincial People’s Hospital. The patients were divided into a MS group and a TEMI group according to the surgery approaches. A comparison of the clinical data between the two groups was conducted. ResultsA total of 196 patients were enrolled, including 133 males and 63 females aged (43.8±14.9) years. There were 103 patients in the MS group and 93 patients in the TEMI group. No hospital death was observed. There was a higher percentage of artificial chordae implantation in the TEMI group compared to the MS group (P=0.020), but there was no statistical difference between the two groups in the other repair techniques (P>0.05). Although the total operation time between the two groups was not statistically different (P=0.265), the TEMI group had longer cardiopulmonary bypass time (P<0.001) and aortic clamp time (P<0.001), and shorter mechanical ventilation time (P<0.001) and postoperative hospitalization time (P<0.001). No statistical difference between the two groups in the adverse perioperative complications (P>0.05). The follow-up rate was 94.2% (180/191) with a mean time of 0.2-12.4 (4.0±2.4) years. Two patients in the MS group died with non-cardiac reasons during the follow-up period. The 3-year, 5-year and 10-year overall survival rates of all patients were 100.0%, 99.2%, 99.2%, respectively. Compared with the MS group, there was no statistical difference in the survival rate, recurrence rate of mitral regurgitation, reoperation rate of mitral valve or adverse cardiovascular and cerebrovascular events in the TEMI group (P＞0.05). ConclusionTEMI approach is a safe, feasible and effective approach for BD with a satisfying long-term efficacy.
Ischemic mitral regurgitation represents a common complication after myocardial infarction, the severity of the mitral regurgitation increases the risk of mortality. There is continuing debate regarding the management of moderate ischemic mitral regurgitation in patients undergoing surgical management. The debates lie in whether adding mitral valve surgery to coronary artery bypass grafting. So the review is about the analysis of existing evidence and expectation about it.
Objective To summarize the surgical treatment strategies and the clinical outcomes of hypertrophic obstructive cardiomyopathy (HOCM) with severe mitral regurgitation. Method We retrospectively analyzed the clinical data of 23 patients of HOCM with severe mitral regurgitation in our hospital from January 2004 through January 2014 year. There were 14 males and 9 females, aged from 15-71(50.2±15.4) years. The preoperative left ventricular outflow tract gradient (LVOTPG) of these patients was 75-161(98.1±19.3) mm Hg. And the septal thickness was 25.8±2.8 mm. All 23 patients had at least moderate mitral regurgitation and systolic anterior motion (SAM). All of them had extend septal myectomy (extend Marrow procedure) and mitral valve repair(MVP),while 4 patients with atrial fibrillation had left atrial ablation and left atrial appendage operation. Results All patients were successfully operated. The left ventricular outflow tract pressure gradient was 16-39(26.9±4.9) mm Hg when the cardiopulmonary bypass stopped and SAM phenomenon was completely eliminated. Except for 2 mitral valve patients with trace amounts of regurgitation, 1 patient with mild regurgitation, the other 20 patients of mitral regurgitation were completely corrected. All patients survived after operation and only 1 patient suffered from transient complete atrioventricular block and then back to normal sinus rhythm. A long-term follow-up from 6 months to 126 months with an average of 53.1±34.9 months showed no late postoperative death. No mitral regurgitation need reoperation. Two patients had mild reflux. Four patients were of trace reflux. The left ventricular outflow tract the maximum pressure gradient was less than 42 mm Hg. The thickness of interventricular septum dropped from preoperative 25.8±2.8 mm to postoperative 14.1±1.3 mm (P<0.001) . No recurrence was noted in the 3 patients with atrial fibrillation. And one patient still had paroxysmal atrial fibrillation. Long term follow-up of the patients' symptoms disappeared or with only mild symptoms. And quality of their life improved significantly. And there was no long-term complication, reoperation, or death. Conclusions The extensive septal myectomy can completely dredge left ventricular outflow tract stenosis and eliminate SAM phenomenon. The mitral valve repair can correct mitral regurgitation. The comprehensive surgical treatment strategy can achieve a good long-term therapeutic effect.