A Comparative Study Of Early And Mid-term Clinical Effects Of Rheumatic Mitral Valvuloplasty And Replacement

Objectives:The clinical efficacy of mitral valvuloplasty in degenerative mitral valve disease is better than replacement surgery.It has been recognized worldwide.However,whether mitral valvuloplasty is suitable for rheumatic disease has been controversial.This study aimed to compare the early and mid-term clinical outcomes of rheumatic mitral valvuloplasty and replacement.Methods:A total of 108 patients with rheumatic mitral valvuloplasty(MVP)underwent rheumatic mitral valvuloplasty(MVP)from December 2014 to November 2019,by Department of Cardiovascular Surgery,Hospital,Kunming Yan’an Hospital,Cardiovascular in Yunnan Province.The patient’s age were 44.26±9.57 years old,of which the largest was 62 years old and the youngest was 21 years old,25 males(23.1%)and 83 females(76.6%).Each patient has undergone a sternotomy.Based on intraoperative exploration of mitral valve lesions,the patients are appropriately selected surgical techniques for MVP.And we performed a water injection test to detect mitral valve function after the repair.Transesophageal echocardiography was used to evaluate the immediate effect of mitral valvuloplasty after cardiac arrest.Whether MVP or mitral valve replacement(MVR)should be performed again depended on the evaluation of the immediate effect of mitral valvuloplasty by transesophageal echocardiography.The patients with rheumatic mitral valve disease who underwent mitral valve replacement surgery in the same period were divided into two groups:the plastic group and the replacement group according to the sex,age and operation time of the successful 80 patients.We collected preoperative,intraoperative and postoperative basic conditions of the two groups of patients.the patients were followed up for survival,symptoms,cardiac function Change and Echocardiography results by telephone,WeChat or outpatient services in 3 months,1 year,2 years,and 3 years.We collect the related data of Echocardiography and compare the changes of various indexes before and after operation.The heart function,adverse events,reoperation and survival rate of the two groups were compared by statistical analysis.Results:A total of 78 cases were successfully formed in the early stage.Among them,2 cases were re-operated due to refluxing 1 week after the operation.The early repair rate was 72.2%.80 cases of MVR in the same period are collected.There were no deaths in the whole group during follow-up time.But 2 cases were lost.The follow-up time varies from 3 to 48 months.The average follow-up time of the MVP group were 12.7±3.52 months.And the average follow-up time of the MVR group were 10.15±4.66 months.3 year the survival rate of the two groups was 100%.During the follow-up period,4 patients in the MVP group underwent the reoperation.And the degrees of freedom from reoperation of 1 year and 3 year were 93.5%and 92.5%respectively.And 1 patient had a second child.The statistical analysis showed that MPG,MR,EF,LV,and LA at different times were statistically different(P<0.05).In Cox multivariate analysis,age may be a predictor of dysfunction after rheumatic mitral valvuloplasty.Compared with the MVR group,the risk of reoperation had increased in the MVP group(P<0.05).There was no statistic significant difference in survival rate,mortality rate and the cardiac function between MVP group and MVR group(P>0.05).The incidence of adverse events in MVR group was higher than that of MVP group(P<0.05).Conclusions:In whole group of rheumatic MVP and MVR have the same clinical efficacy and safety in the early stage.In the mid-term follow-up,the incidence of adverse events in MVP group was lower than the MVR group.The quality of life in MVP group was better than the MVR group.But the reoperation rate of MVP group was higher than the MVR group.There was no difference in survival rate between the two groups in the middle tine.The long-term results still need to be observed.We suggest careful selection of appropriate cases of rheumatic mitral valve.especially those who are unable to resist Concentration monitoring,young people or women of childbearing age.