Observation And Treatment Of Mitral Valve Replacement Combined With Left Atrial Plication In Perioperative Period

Objective:To observe the the cardiac function of patients after mitral valve replacement(MVR)combined with left atrial plication in perioperative period,and to summarize the experience of perioperative period treatment of these patients in order to provide guidance for postoperative treatment of such patients.Methods:We retrospectively analyzed the clinical data from patients undergoing mitral valve replacement(MVR)combined with tricuspid annuloplasty(TAP),and from patients receiving MVR and TAP and left atrium placation(LAP)in the Affiliated Hospital of Zunyi Medical College from January 2015 to December 2016,and only 42 in 176 cases met the inclusion criteria.The patients were divided into the control group and LAP group treated with MVR with 21 patients in each group,TAP and LAP depending on whether for LAP or not.Patients received MVR and TAP were taken as the control group,while patients for MVR and TAP and LAP were taken as the LAP group treated with MVR,TAP and LAP.The ascending aortic clamping time(min),extracorporeal circulation time(min),assistor respiration time after operation ICU(h),treatment time after operation ICU(h),length of stay after operation(day),vasoactive-inotropic score(VIS)of the operation day and 3 days later,cardio-thoracic ratio(C/T)and the left atrium diameter(LAD)before operation and before discharge,left ventricular ejection fraction,left ventricular fraction shortening(FS)value were observed and analyzed.Results:1.There was no difference in the preoperative general condition between the control group and the LAP group treated with MVR,TAP and LAP.2.The average ascending aortic clamping time,extracorporeal circulation time,postoperative assisted respiration time,and the postoperative ICU treatment time was 53±12 min,98±28 min,28±19 h and 61±34 h,respectively,in the control group,versus 65±14 min,108±26 min,36±23 h,and 72±38 h,in the LAP group treated with MVR,TAP and LAP,Significant difference was found between these two groups(all P<0.01).3.The postoperative length of stay in the control group was 12.63±4.11 day,while that of the LAP group treated with MVR,TAP and LAP was 12.52±3.29 day,No significant difference was found between these two groups(P>0.05).4.The VIS on the day of operation,on day 1 and 2 after operation were 15.28 ± 4.41,12.42 ± 4.01 and 8.26 ± 3.11,respectively,in the control group,versus 19.68±6.32,18.42±5.72 and 11.32±3.64,in the LAP group treated with MVR,TAP and LAP,Significant difference was found between these two groups(P<0.01);on day 3,the VIS in the control and LAP group treated with MVR,TAP and LAPs were8.02±3.32 and 7.82±2.96,respectively,No significant difference was found between these two groups(P>0.05).5.After operation,the diameter of left atrium of the control group was(69±11)mm,while that of the LAP group treated with MVR,TAP and LAP was(62±8)mm,Significant difference was found between these two groups(P<0.01).6.After operation,the C/T of the control group was 0.66±0.04,while that of the LAP group treated with MVR,TAP and LAP was 0.59±0.03,Significant difference was found between these two groups(P<0.05).7.The postoperative LVEF value was 59%±4.6% in the control group versus 65%±3.2% in the LAP group treated with MVR,TAP and LAP,Significant difference was found between these two groups(P<0.05).The postoperative LVFS value of the control group was 33%±2.9%,and that in the LAP group treated with MVR,TAP and LAP was 37%±2.8%,Significant difference was found between these two groups(P<0.05).Conclusion:MVR and TAP combined with LAP can significantly reduce postoperative left atrial diameter and C/T,reduced left atrium,reduce the pressure of GLA on the surrounding organ tissues,and improve the cardiac function of perioperative GLA patients.LAP may increase cardiac injury and affect the cardiac function transiently;within three days after surgery,the patients need more large doses of vasoactive drugs to support the treatment,and need more ventilator-assisted breathing time and ICU treatment time.Therefore,but the perioperative treatment can make the cardiac function recover faster.