Objective To summarize the experiences of surgical treatment for post infarction ventricular aneurysm and mi tral regurgitation， thus to improve surgical curative effect and survival rates . Clinical data of 37 patients with myocardial infarction complicated with ven tricular aneurysm and severer than moderate mitral regurgitation were retrospectively an alyzed between December 2000 and June 2007, all 37 patients underwent coron ary artery bypass grafting and reconstruction of left ventricular after aneurysm resection, mitral valve repair or replacement. Results Three patients died during hospital stay after surgery,mortality rate was 81%, of th em two died in renal failure, one died in brain complications.Thirty patients we re followed up, followup rate was 88.2%(30/34), with 4 patients missed. Follow up time ranged from 1 month to 6 years after surgery, 2 patients died in foll o wup period, of them one died in anticoagulant treatment failure complicated w ith the large cerebral infarction, one died of lung infection and heart failure. The inner diameter of le ft atrium and enddiastolic left ventricle reduced obviously than those before operation （30.1±3.5mm vs.39.3±3.7mm, P=0.004;48.4±4.3mm vs.61.2±5.1mm, P=0.003）by color doppler echocardiography examination at 6th month a fter su rgery.There was no obvious change in size of untouched ventricular aneurysm(diam eterlt;5cm). No regurgitation or slight regurgitation were observed in 12 patient s, mild regurgitation was observed in 2 patients and moderate in 1 patients. Conclusion According to different types of post infarctio n ventricular aneurysm and mitral regurgitation, constitution o f different surgical treatment programs, can result in favorable early and long-term curative effect. There’s marked improvement in most patients’cardiac f unction and survival rate.
ObjectiveThrough comparing the therapeutic efficacy of robot-assisted surgery (RS) and conventional surgery (CS) for mitral valve disease by meta-analysis to guide the choice of clinical operation.MethodsDatabases including The Cochrane Library, PubMed, EMbase, China National Knowledge Infrastructure (CNKI), China Biology Medicine disc (CBMdisc) and Wanfang Database were searched by computer from inception to June 2020. The literature of efficacy comparison between RS and CS was collected. Two reviewers independently screened the literature according to inclusion and exclusion criteria, extracted the data, and evaluated the quality of the literature. Meta-analysis was performed using RevMan 5.4 software.ResultsWe identified 11 studies of RS versus CS with 4 330 patients. Among them, 2 212 patients underwent RS and 2 118 underwent CS. Meta-analysis demonstrated that compared with the CS, RS had longer cross-clamp time (MD=25.00, 95%CI 15.04 to 34.95, P<0.000 01), cardiopulmonary bypass time (MD=44.11, 95%CI 29.26 to 58.96, P<0.000 01) and operation time (MD=46.40, 95%CI 31.55 to 61.26, P<0.000 01). However, ICU stay (MD=–22.13, 95%CI –31.88 to –12.38, P<0.000 01) and hospital stay (MD=–1.81, 95%CI –2.69 to –0.92, P<0.000 01) were significantly shorter in the RS group; and the incidences of blood transfusion (OR=0.38, 95%CI 0.16 to 0.89, P=0.03) and complications (OR=0.73, 95%CI 0.57 to 0.94, P=0.01) were significantly lower in the RS group.ConclusionAlthough RS has a longer operation time than CS, it has less damage, less bleeding, faster recovery and better curative efficacy.
ObjectiveTo investigate the effect of concomitant tricuspid valve repair during mitral valve surgery on the early and mid-term prognosis of the tricuspid valve and right heart function in the patients with moderate or less tricuspid regurgitation. MethodsA retrospective study of 461 patients with mitral valve disease requiring cardiac surgery combined with moderate or less tricuspid regurgitation in our hospital from 2011 to 2014 was done. They were 309 males and 152 females with a median age of 53.00 (44.00, 60.00) years. According to whether they received tricuspid valve repair (Kay’s annuloplasty, DeVega’s annuloplasty or annular ring implantation), the patients were divided into a mitral valve surgery only group (a nTAP group, n=289) and a concomitant tricuspid valve repair group (a TAP group, n=172). At the same time, 43 patients whose tricuspid valve annulus diameter was less than 40 mm in the TAP group were analyzed in subgroups. ResultsThe median follow-up duration was 3.00 years (range from 0.10 to 9.30 years). There was no perioperative death. Three months after surgery, the anteroposterior diameter of the right ventricle in the TAP group was significantly improved compared with that in the nTAP group [–1.00 (–3.00, 1.00) mm vs. 0.00 (–0.20, 2.00) mm, P=0.048]. Three years after surgery, the improvement of right ventricular anteroposterior diameter in the TAP group was still significant compared with the nTAP group [–1.00 (–2.75, 2.00) mm vs. 2.00 (–0.75, 4.00) mm, P=0.014], and the patients in the TAP group were less likely to develop moderate or more tricuspid regurgitation (3.64% vs. 35.64%, P<0.001). Annuloplasty ring implantation was more effective in preventing regurgitation progression (P=0.044). For patients with a tricuspid annulus diameter less than 40 mm, concomitant tricuspid valve repair was still effective in improving the anteroposterior diameter of the right ventricle in the early follow-up (P=0.036). Conclusion Concomitant tricuspid valve repair for patients with moderate or less tricuspid regurgitation during mitral valve surgery can effectively improve the tricuspid valve and right heart function in the early and mid-term after surgery. Annuloplasty ring implantation is more effective in preventing regurgitation progression. Patients whose tricuspid annulus diameter is less than 40 mm can also benefit from concomitant tricuspid repair.
ObjectiveTo compare early outcomes of the minimally invasive mitral valve surgery (MIMVS) through right anterolateral mini-thoracotomy (ALMT) with conventional mitral valve surgery (MVS), and evaluate feasibility and safety of MIMVS. MethodsFrom January 2011 to December 2013, 120 patients undergoing elective MVS in Nanjing First Hospital were prospectively enrolled in this study. There were 72 male and 48 female patients with their age of 22-71 (42.4±11.0) years. Using a random number table, all the patients were randomly divided into a portaccess MIMVS group (MIMVS group, n=60) and a conventional MVS group (conventional group, n=60). MIMVS group patients received port-access cardiopulmonary bypass (CPB) establishment via femoral artery, femoral vein and right internal jugular vein cannulation through right ALMT 5-6 cm in length. Special MIMVS operative instruments were used for mitral valve repair or replacement. Conventional group patients received mitral valve repair or replacement under conventional CPB through median sternotomy. Perioperative clinical data, morbidity and mortality were compared between the 2 groups. ResultsThere was no death in-hospital or shortly after discharge in this study. CPB time (98.0±26.0 minutes vs. 63.0±21.0 minutes) and aortic cross-clamping time (68.0±9.0 minutes vs.37.0±6.0 minutes) of MIMVS group were significantly longer than those of conventional group (P<0.05). Postoperative mechanical ventilation time (6.0±3.9 hours vs. 11.2±5.6 hours), length of ICU stay (18.5±3.0 hours vs. 28.6±9.5 hours) and postoperative hospital stay (8.0±2.0 days vs. 13.5±2.5 days) of MIMVS group were significantly shorter than those of conventional group (P<0.05). Chest drainage volume within postoperative 12 hours (110.0±30.0 ml vs. 385.0±95.0 ml) and the percentage of patients receiving blood transfusion (25.0% vs. 58.3%) of MIMVS group were significantly lower than those of conventional group (P<0.05). Patients were followed up for 1-24 months, and the follow-up rate was 94.2%. There was no statistical difference in postoperative morbidity or mortality between the 2 groups (P>0.05). ConclusionMIMVS through right ALMT is a safe and feasible procedure for surgical treatment of mitral valve diseases. MIMVS can achieve similar clinical outcomes as conventional MVS, but can significantly shorten postoperative ICU stay and hospital stay, reduce blood transfusion, and is a good alternative to conventional MVS.
ObjectiveTo analyze factors affecting the recovery of postoperative left ventricular function in patients with valvular disease combined with heart failure with reduced ejection fraction [HFrEF, left ventricular ejection fraction (LVEF)<40%].MethodsThe clinical data of 98 patients with valvular disease combined with HFrEF who underwent surgeries in our hospital from January 2011 to June 2018 were retrospectively analyzed, including 75 males and 23 females aged 9-78 (55.3±11.9) years.ResultsA total of 15 patients were dead after the operation, including 4 deaths within 3 months and 11 mid-long-term deaths after the operation. Ninety-one patients were followed up for more than 6 months (10 months to 8.6 years). The postoperative cardiac function (NYHA) of 91 patients was classⅠ-Ⅱ, the LVEF of 18 (19.8%) patients increased more than 10%, that of 47 (51.6%) patients maintained at the preoperative level, and that of 26 (28.6%) patients decreased. Postoperative LVEF was more prone to recover in HFrEF patients with sinus rhythm before operation (P=0.038), valvular disease mainly in aortic valve (P=0.026), obvious reduction of left ventricular end diastolic diameter in early postoperative period (P=0.017), and higher systolic pulmonary artery pressure (SPAP) before operation (P=0.018). The risk factors for postoperative LVEF deterioration included large left atrium before operation (P=0.014), smaller left ventricle end systolic diameter before operation (P=0.003), and fast heart rate after operation (P=0.019). ConclusionMitral valve prolapse patients with obviously increased left ventricular diameter should receive operation as soon as possible. HFrEF patients with aortic valve disease should receive operation positively. The operation efficacy is satisfactory in the HFrEF patients with high SPAP.
Objective To summarize the outcomes and clinical features for surgical treatment of nonischemic heart valve disease(HVD) combined with coronary artery disease(CAD), so that to get better surgical result. Methods From January 2000 to June 2007, 105 patients with the mean age of 61.96±7.61 years (range 36-79 years), underwent the combined procedures.The etiology of HVD included: 59 rheumatic valve disease, 24 degenerative mitral lesion, 13 calcified aortic valve lesion, and 9 other aortic valve disease. CAD was preoperatively diagnosed by coronary arteriongraphy in 98 patients, and intraoperatively identified in 7 patients. Left ventricular ejection fraction was 50% or less in 45 patients. The total number of bypass grafts was 216 with the mean of 2.06 grafts per patient. Valve procedures included: 36 mitral valve valve replacement, 15 mitral repair,43 aortic valve replacement, 11 mitral valve and aortic valve replacement. Results There were 6 postoperative deaths with the mortality of 5.7%. The causes of death were 3 low cardiac output syndrome, 2 renal failure, and 1 heart arrest resulting in multiple organs failure. Ninety-three survivals were followed up from 1 month to 7 years, 6 patients were missed on follow-up. There were no late death. New York Heart Association class Ⅰ was observed in 25 patients, class Ⅱ53, class Ⅲ 10 and class Ⅳ 5. One patient still had existential chest pain. Conclusion There were no typical angina in majority of patients with nonischemic HVD combined with CAD, coronary arteriongraphy must be taken in patients with the age of 50 years and more, or with the risk factors for CAD.Intraoperative myocardial protection is very important because CAD further deteriorates myocardial dysfunction caused by HVD.The decreased left ventricular function is the important factor affecting the surgical results and it is hard to evaluate the underlying cause before the operation.
ObjectiveTo assess the accuracy of European System for Cardiac Operative Risk Evaluation (EuroSCORE) model in predicting the in-hospital mortality of Uyghur patients and Han nationality patients undergoing heart valve surgery. MethodsClinical data of 361 consecutive patients who underwent heart valve surgery at our center from September 2012 to December 2013 were collected, including 209 Uyghur patients and 152 Han nationality patients. According to the score for additive and logistic EuroSCORE models, the patients were divided into 3 subgroups including a low risk subgroup, a moderate risk subgroup, and a high risk subgroup. The actual and predicted mortality of each risk subgroup were studied and compared. Calibration of the EuroSCORE model was assessed by the test of goodness of fit, discrimination was tested by calculating the area under the receiver operating characteristic (ROC) curve. ResultsThe actual mortality was 8.03% for overall patients, 6.70% for Uyghur patients,and 9.87% for Han nationality patients. The predicted mortality by additive EuroSCORE and logistic EuroSCORE for Uyghur patients were 4.03% and 3.37%,for Han nationality patients were 4.43% and 3.77%, significantly lower than actual mortality (P<0.01). The area under the ROC curve of additive EuroSCORE and logistic EuroSCORE for overall patients were 0.606 and 0.598, for Han nationality patients were 0.574 and 0.553,and for Uyghur patients were 0.609 and 0.610. ConclusionThe additive and logistic EuroSCORE are unable to predict the in-hospital mortality accurately for Uyghur and Han nationality patients undergoing heart valve surgery. Clinical use of these model should be considered cautiously.
Objective To summarize the clinical characteristics and management experiences of patients with severe tricuspid regurgitation (TR) after mitral valve surgery. Methods Thirty patients were followed up and reviewed for this report. There were 1 male and 29 female patients whose ages ranged from 32 to 65 years (47.1±92 years). A total of 28 patients had atrial fibrillation and 2 patients were in sinus rhythm. There were 13 patients of mild TR, 10 patients of moderate TR and 7 patients of severe TR at the first mitral valve surgery. Five patients received the tricuspid annuloplasty of De Vega procedure at the same time, 2 patients received Kay procedure. The predominant presentation of patients included: abdominal discomfort (93.3%, 28/30), edema (66.7%,20/30), palpitation (56.7%, 17/30), and ascites (20%, 6/30). Results Nine patients underwent the secondary surgery for severe TR. The secondary surgery included tricuspid valve replacement (6 cases), mitral and tricuspid valve replacement (2 cases) and Kay procedure (1 case). Eight patients were recovered and discharged and 1 patient died from the bleeding of right atrial incision and low output syndrome. Twentyone patients received medical management and were followed up. One case was lost during followup. Conclusion Surgery or medical management should be based on the clinical characteristics of patients with severe TR after mitral valve surgery. It should be based on the features of tricuspid valve and the clinical experience of surgeon to perform tricuspid annuloplasty or replacement.
Abstract： Objective To establish a risk prediction model and risk score for inhospital mortality in heart valve surgery patients, in order to promote its perioperative safety. Methods We collected records of 4 032 consecutive patients who underwent aortic valve replacement, mitral valve repair, mitral valve replacement, or aortic and mitral combination procedure in Changhai hospital from January 1,1998 to December 31,2008. Their average age was 45.90±13.60 years and included 1 876 (46.53%) males and 2 156 (53.57%) females. Based on the valve operated on, we divided the patients into three groups including mitral valve surgery group (n=1 910), aortic valve surgery group (n=724), and mitral plus aortic valve surgery group (n=1 398). The population was divided a 60% development sample (n=2 418) and a 40% validation sample (n=1 614). We identified potential risk factors, conducted univariate analysis and multifactor logistic regression to determine the independent risk factors and set up a risk model. The calibration and discrimination of the model were assessed by the HosmerLemeshow (H-L) test and [CM(159mm]the area under the receiver operating characteristic (ROC) curve,respectively. We finally produced a risk score according to the coefficient β and rank of variables in the logistic regression model. Results The general inhospital mortality of the whole group was 4.74% (191/4 032). The results of multifactor logistic regression analysis showed that eight variables including tricuspid valve incompetence with OR=1.33 and 95%CI 1.071 to 1.648, arotic valve stenosis with OR=1.34 and 95%CI 1.082 to 1.659, chronic lung disease with OR=2.11 and 95%CI 1.292 to 3.455, left ventricular ejection fraction with OR=1.55 and 95%CI 1.081 to 2.234, critical preoperative status with OR=2.69 and 95%CI 1.499 to 4.821, NYHA ⅢⅣ (New York Heart Association) with OR=2.75 and 95%CI 1.343 to 5641, concomitant coronary artery bypass graft surgery (CABG) with OR=3.02 and 95%CI 1.405 to 6.483, and serum creatinine just before surgery with OR=4.16 and 95%CI 1.979 to 8.766 were independently correlated with inhospital mortality. Our risk model showed good calibration and discriminative power for all the groups. P values of H-L test were all higher than 0.05 (development sample: χ2=1.615, P=0.830, validation sample: χ2=2.218, P=0.200, mitral valve surgery sample: χ2=5.175,P=0.470, aortic valve surgery sample: χ2=12.708, P=0.090, mitral plus aortic valve surgery sample: χ2=3.875, P=0.380), and the areas under the ROC curve were all larger than 0.70 (development sample: 0.757 with 95%CI 0.712 to 0.802, validation sample: 0.754 and 95%CI 0.701 to 0806; mitral valve surgery sample: 0.760 and 95%CI 0.706 to 0.813, aortic valve surgery sample: 0.803 and 95%CI 0.738 to 0.868, mitral plus aortic valve surgery sample: 0.727 and 95%CI 0.668 to 0.785). The risk score was successfully established: tricuspid valve regurgitation (mild:1 point, moderate: 2 points, severe:3 points), arotic valve stenosis (mild: 1 point, moderate: 2 points, severe: 3 points), chronic lung disease (3 points), left ventricular ejection fraction (40% to 50%: 2 points, 30% to 40%: 4 points, ＜30%: 6 points), critical preoperative status (3 points), NYHA IIIIV (4 points), concomitant CABG (4 points), and serum creatinine (＞110 μmol/L: 5 points).Conclusion Eight risk factors including tricuspid valve regurgitation are independent risk factors associated with inhospital mortality of heart valve surgery patients in China. The established risk model and risk score have good calibration and discrimination in predicting inhospital mortality of heart valve surgery patients.
ObjectiveTo analyze the early and mid-term safety and effectiveness of concomitant cryosurgical Cox-Maze Ⅳ procedure in minimally invasive mitral valve surgery.MethodsWe retrospectively reviewed the clinical data of 68 patients (28 males and 40 females with a mean age of 38.7±9.3 years) who underwent concomitant cryosurgical Cox-Maze Ⅳ procedure in minimally invasive mitral valve and tricuspid surgery in the Department of Cardiovascular Surgery of the Second Xiangya Hospital from August 2013 to October 2017. The heart rhythm of the patients after surgery was supervised by 24 hour holter monitoring eletrocardiogram.ResultsNo death occurred during operation and follow-up. One patient underwent reexploration for bleeding. The rate of sinus rhythm restored at the time of discharge was 95.8%. The rate of sinus rhythm restored at 6 months, 12 months, 24 months, 36 months after surgery was 93.5%, 91.6%, 90.3% and 89.5% respectively.ConclusionConcomitant cryosurgical Cox-Maze Ⅳ procedure in minimally invasive mitral valve surgery is quite safe and effective in treatment of rheumatic mitral valve disease and atrial fibrillation in the early and mid-term follow-up.