| Objective:Through statistical follow-up data of patients with mitral valve insufficiency treated by mitral valvuloplasty at different stages,a retrospective study of 99 patients with mitral valvuloplasty from January 2016to December 2021 in the Department of Cardiovascular Surgery of the Second Hospital of Hebei Medical University the early to mid-term outcomes,the incidence of adverse events and risk factors were analyzed,in order to increase the surgical experience and improve surgical outcomes.Methods:From January 2016 to December 2021,the Department of Cardiovascular Surgery of the Second Hospital of Hebei Medical University performed mitral valvuloplasty on 99 patients with mitral regurgitation,including 53 males and 46 females,aged 16～69 years,with an average age(46.52±11.17)years old,average height(167.60±7.67)cm,average weight(69.64±14.47)kg.Classification of etiology:60 patients with degenerative diseases(5 patients with Barlow’s disease),16 patients with ischemic diseases,19 patients with rheumatic diseases,3 patients with congenital diseases,and 1patient with infective endocarditis.Preoperative electrocardiogram:71patients with sinus rhythm,27 patients with arrhythmia,and 1 patient with complete atrioventricular block.Preoperative New York Heart Association cardiac function classification:8 patients were grade II,57 patients were grade III,and 34 patients were grade IV.There were 96 patients with left ventricular ejection fraction≥40%and 3 patients with less than 40%postoperative.Coronary angiography examination in 43 cases,coronary angiography vascular stenosis in 16 cases.Carpentier valve functional type:3 patients with Carpentier typeⅠ,74 patients with Carpentier typeⅡ,and 22 patients with Carpentier typeⅢ.During the operation,the patient is placed in the supine position(sternum sawed through the middle or VATS),general anesthesia,endotracheal intubation,and light hypothermia(28-30°C)assisted by extracorporeal circulation to perform mitral valvuloplasty,and 95 cases with sternum sawed through the middle,4 cases with VATS.The statistics of mitral annuloplasty techniques are as follows:36 patients with wedge-shaped,rectangular or butterfly resection,0 patients with valve leaflet enlargement,11patients with valve leaflet folding,19 patients with valve leaflet thinning,16patients with valve leaflet fissure closure,and edge-to-edge suturing of leaflets in 16 cases,valve leaflet sliding suture in 5 cases,junctional suture in 14 cases,junctional incision in 19 cases,Gore-Tex artificial chord implantation in 25cases,chordae shortening in 4 cases,and chordae transfer in 9 cases,partial chordectomy in 3 cases,papillary myotomy in 4 cases,and artificial valve ring implantation in 98 cases.Follow-up case data were input and classified using Microsoft Excel 2019 worksheets,and IBM SPSS Statistics 26.0 software was used for statistical analysis.Results:A total of 99 patients were followed up postoperative.The follow-up ended on December 31,2022.The follow-up time ranged from 13to 82 months,with an average follow-up of(40.60±15.57)months.None of the 99 patients died during the perioperative period.The average cardiopulmonary bypass time of the whole group was(101.31±39.35)minutes,the average aortic occlusion time was(62.17±37.62)minutes,the average ventilator assistance time was(18.50±17.04)hours,and the average cardiac The stay time in vascular intensive care unit was(30.83±17.33)hours,the average hospitalization days were(21.68±9.20)days,the average preoperative hospitalization days were(14.38±7.65)days,and the average postoperative hospitalization days were(7.40±3.88)days.Complications occurred in 8patients during the perioperative period,4 patients with new arrhythmia(2patients with atrial fibrillation,2 patients with atrial flutter),1 patient with secondary operation for probing hemostasis,1 patient with acute heart failure,and patient with acute gastrointestinal bleeding in 2 people.One week postoperative,New York Heart Association cardiac function classification:60patients were grade I,31 patients were grade II,and 8 patients were grade III.Echocardiographic results preoperative and 1 week postoperative:the mean effective mitral valve regurgitation area preoperative was(8.24±4.46)cm~2,and the mean value decreased to(0.18±0.06)cm~2 at 1 week postoperative(P<0.001);The mean value of left ventricular ejection fraction preoperative was(54.53±7.34)%,which changed to(63.50±6.74)%at 1 week postoperative(P<0.001);week decreased to(35.50±6.76)mm(P<0.05);the mean left ventricular end-diastolic diameter preoperative was(54.92±7.41)mm,and decreased to(48.00±5.69)mm 1 week postoperative(P<0.05);The mean end-systolic diameter of the left ventricle preoperative was(36.34±6.28)mm,which changed to(33.75±5.15)mm at 1 week postoperative(P<0.05),and the mean height of the bicuspid valve leaflets at 1 week postoperative was(6.64±1.14)mm,88 patients had no regurgitation or slight regurgitation 1week postoperative,and 11 patients had slight regurgitation.The condition of all patients in the group improved and they were discharged from hospital.During the follow-up period,0 patients died at 1 year postoperative,and the cumulative survival rate was 100%;1 patient died at 5 years postoperative,and the cumulative survival rate was 99.0%.There were 4 patients with moderate or severe mitral regurgitation 1 year postoperative,with a regurgitation rate of 4.04%;10 patients with recurrent moderate or severe mitral regurgitation 5 years postoperative,with a regurgitation rate of 10.10%.2 mitral valve reoperations were performed 1 year postoperative,and the reoperation rate was 2.02%;6 mitral valve reoperations were performed 5years postoperative,and the reoperation rate was 6.06%.10 patients had atrial fibrillation rhythm of 5 years postoperative,1 patient underwent transcatheter aortic valve implantation due to severe aortic valve insufficiency 2 years postoperative,2 patients developed severe pulmonary hypertension,and 2patients had mild SAM sign.During the follow-up period,all patients had no hemorrhage,embolism,myocardial infarction,severe arrhythmia,infective endocarditis,wound infection,liver and kidney insufficiency and other adverse events.Conclusions:The clinical outcomes effective and reliable of mitral valvuloplasty,achieving good early to mid-term survival and freedom from reoperation rates.After mitral valvuloplasty,the symptoms of mitral regurgitation and cardiac function can be significantly improved,with short postoperative hospital stays and rapid recovery of cardiac function,and the rate of mitral valve regurgitation,reoperation rate,mortality rate,and adverse events in the early to mid-term after surgery are kept low,which has a significant advantages over mitral valve replacement.However,patients with residual mitral regurgitation and the overlapping height of the anterior and posterior mitral leaflets was less than 5 mm have higher risk of reoperation. |
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