| With the recognization of physiological function of mitral apparatus and the relation to left ventricular function, based on conventional mitral valve replacement ( MVRC) , a new concept is being accepted : mitral valve replacement with preservation of subvalvalar apparatus (MVRP).In recent years some authors reported patients "perioprative outcomes underwent conventional mitral valve replacement and mitral valve replacement with preservation of sub valvular apparatus. They believed that MVRP is better than MVRC in both mortality and improvement of hemodynamics. But there are no long term follow up results, especially no assessment of some important index , such as ejection fraction (EF) and rate of survival . There are also some opposite opinions for a long time on the beneficial effect of MVRP on different mitral valve pathological conditions , such as mitral stenosis ( MS ) A mitral regurgitation ( MR) and others cases.The morbidity of mitral valve disease is an overwhelming majority among all valve disease . Make it clear that MVRP is beneficial for improvement of cardiac function and long term survival, identify what influence of MVRP of cardiac function and long term survival in different mitral valve pathological conditions, will make far - reaching historical significance in mitral valve operation.In order to answer these questions, we made retrospective analy-sis in all patients performed MVRP and MVRC in the latest decade. PATIENTS AND METHODSBetween Jan 1992 and Jun 2001, 487 patients without complication were operated on mitral valve replacement with mechanical proth-esis. 57 patients underwent MVRP (Group I ) ,and the others underwent MVRC (Group H ) -Statistic package for social science (SPSS) is used. Statistic significance between perioperation mortality ( from 1 to 30 days postoper-ation) of two groups were determined by x test. Ejection fraction of preoperation and follow up time, in each group and between two groups were determined by t - test analysis respectively. Life table curves were plotted by the method of Kaplan - Meier and analyzed by Log Rank test. According to the result of survival analysis, use COX proportional hazard regression to find out the relative factors to successful incident.RESULT1. There is no statistic significant difference between perioperative mortality of two groups. ( 3/57 Vs 26/430 , P >0.05) .2. Follow up results in each group, compared with preoperation, has a significant improvement ( P < 0. 01).3. With Hotelling comprehensive test, compared with preoperation, the follow up time, ejection fraction has a significant improvement, means each method can improve EF satisfied.4. In each follow up step, compared with Group H ( MVRC) ,EF, in Group I (MVRP) has a significant improvement.5. The mean rate of survival, Group I (MVRP) is higher than Group H (MVRC). After the fifth year, there is a significant difference between two groups, but there is no statistic significance in the whole..6. If a patient had passed 5 years or longer after operation is looked as the successful incident, at the level P equals 0. 20, age, cardiac function of preoperation ( EF) and method of operation come into model. Namely, they are relative factors influence the patients' rate of five - year survival.DISCUSSIONPatients suffered from mitral valve disease without complication, after mitral valve replacement ( MVR) , both MVRP and MVRC can improve EF significantly. It can be said, MVR is an effective method on mitral valve disease. Both on every time spot and in general during 1-10 years follow up period, EF of Group I ( MVRP) has more significant difference than Group H ( MVRC ) , means MVRP is better than MVRC in the recovery of cardiac function.It is different from some reports earlier that the rate of periopera-tive mortality between Group I ( MVRP) and Group H ( MVRC ) has no statistic significance. It probably dues to rapid progress of some ra-letive reasons, such as cardiopulmonary bypass, knowledge of mitral valve replacem... |
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