The Comparison Of Short-term Outcome Of Different Surgical Treatments In Patients With Severe Primary Mitral Regurgitation And Large Left Ventricle

ObjectiveTo evaluate the outcome of different surgical methods of severe primary mitral regurgitation with the large left ventricle.MethodWe retrospectively analyzed the clinical data of 72 patients with large left ventricle which had mitral valve surgery(according to 2014 AHA/ACC Guideline for the Management of Patients With Valvular Heart Disease,the patients whose LVEDD?65 mm are considered have large left ventricle).The heart color ultrasound were performed to record the indexes of cardiac function.The patient underwent 1month of new adverse events(new cardiovascular events,cerebral infarction,lung function failure,renal failure),24 months postoperative survival and adverse events(cerebral infarction,severe reflux of mitral valve,heart rate failure).According to the two groups of mitral valve replacement or mitral valve forming,we analyzed the indexes of the two groups:1.hospitalization period,new adverse events;2.the left ventricular end-diastolic dimension,Left ventricular ejection fraction,left ventricular end-systolic volume,left ventricular end-systolic volume index of preoperative,1 mouth after surgery,3 months after surgery,and 12 months after surgery;3.Survival and adverse events occurred 24 months after surgery.Chi-square test was used to compare the incidence of complications 30 days after surgery.Paired t-test was used for postoperative hospital stay;?~2test was used for perioperative complication rate;log-rank test was used for adverse heart or cerebrovascular events and mortality after 24 months;the quantitative data of cardiac function and cardiac structure were compared by repeated measures data analysis of variance.ResultThe median follow-up time was 24 months.A total of 72 patients participated in the survey,two cases in the group with mitral valve repair died,3 cases were lost and 31 cases were followed up,the group with mitral valve replacement was killed in 2 cases,4 cases were lost and 30 cases were followed up.The incidence of postoperative cardioascular events and the hospitalization period in the group with mitral valve repair was lower than that in the group with mitral valve replacement,and the difference was statistically significant(p<0.05).The incidence of other adverse events(cerebral infarction,lung function failure,renal failure)was not statistically significant.In the two groups,there was no statistically significant difference between the differences between left ventricular end-diastolic dimension(LVEDD),left ventricular ejection fraction(LVEF),left ventricular end-systolic volume(LVESV)and left ventricular end-systolic volume index(LVESVI)in the preoperative period,perioperative period,3 months after operation,and 12 months after surgery,The incidence of cerebral infarction complications in the two groups was statistically significant(p<0.05),and the incidence of mortality and other serious adverse events(Severe mitral regurgitation,heart rate failure)was not significantly different.The incidence of complications of 1 month after surgery was compared by chi-square test.Repeated measurement analysis of variance was used to analyze the indicators of the heart and Student's t test was used to length of stay.Log-rank test was used to analyze Mortality and adverse events occurred 24months after surgery.Conclusion1.In patients with giant left ventricular and severe primary mitral regurgitation,left cardiac function gradually recovered after surgery,and left ventricular remodeling improved significantly.2.In these patients,there was no difference in left heart remodeling and biennial mortality between groups.But the mitral valve repair group has an advantage in improving cardiac function during perioperative period and avoiding postoperative anticoagulation related complications.