Comparison Of The Effects Of Mitral Valvuloplasty And Mitral Valve Replacement In The Treatment Of Severe Ischemic Mitral Regurgitation

Background and Objective:Heart disease is a relatively common circulatory system disease,every year,millions of people died of heart disease in China.Heart disease is divided into congenital heart disease and acquired heart disease.With the continuous development of prenatal diagnosis technology,the number of patients with congenital heart disease presents a declining trend,and the proportion of acquired heart disease in total heart disease increases.The pathogenic factors of acquired heart disease are complex,with more complications,easy to be sudden and fatal,and great social harm.In recent years,the incidence of heart disease and the number of sudden cardiac death events are increasing.The main reasons for this change include:with the rapid economic development and the promotion of building a well-off society in an all-round way,people's living conditions have changed significantly,especially the imbalance of diet structure and the formation of bad habits in work and life,resulting in the increase in the incidence of hypertension,hyperlipidemia,hyperglycemia and obesity year by year,and the incidence tends to be younger.Acquired heart disease in adults in our country,to coronary atherosclerotic heart disease?hereinafter referred to as the coronary heart disease?and cardiac valvular disease?hereinafter referred to as the valvular disease?is the most common,when two diseases exist at the same time,the condition is often complicated.Coronary heart disease?CHD?combined valvular disease include mitral or aortic valve lesions,ischemic mitral regurgitation?IMR?is relatively common after myocardial infarction of coronary heart disease,which accounts for 10%²0%of CHD with valvular disease^[1],Combined IMR often indicates poor prognosis^[2].Patients with IMR were considered as an independent predictor of the risk of high mortality,and the mortality rate of patients with IMR was positively correlated with the degree of mitral regurgitation^[3].Surgical treatment is still the most effective treatment for ischemic mitral regurgitation,mainly including mitral valvuloplasty and replacement.However,due to the complicated pathogenesis of ischemic mitral regurgitation,the optimal surgical method is still controversial.In this study,78 patients with coronary heart disease complicated with severe IMR admitted to the first affiliated hospital of Zhengzhou University were selected,all of whom underwent coronary artery bypass grafting and mitral valvuloplasty or coronary artery bypass grafting and mitral valve replacement,to compare the short-term and medium-term treatment effects of the two groups,hoping to provide a basis for future clinical work.Materials and MethodsA total of 78 patients with coronary heart disease complicated with severe IMR admitted to the first affiliated hospital of Zhengzhou University from January 2011to January 2017 were collected.Inclusion criteria:?1?Coronary artery bypass grafting combined with mitral valve surgery was performed at an appropriate time;?1?Preoperative echocardiography:mitral valve severe regurgitation?reflux bunch of the most widespread hereinafter referred to as reflux area>8 cm²?.Exclusion criteria:?1?Combined with other organic heart disease,parallel operation;?2?Mitral valvuloplasty is not very effective,Intraoperative mitral valve replacement;?3?Medical history,preoperative echocardiography,intraoperative visual exploration and postoperative pathology indicated that mitral valve regurgitation was primary?rheumatic,infectious and degenerative?.The choice of mitral valve operation plan of patients is mainly determined by the valve lesion condition,the willingness of patients and their families.Due to the difference of two groups of patients with preoperative LVEF and LVEDD no statistical significance,so this research conclusion didn't influence.It was divided into MVP group?46 cases?and MVR group?32 cases?,According to mitral valve surgical approach.The mid-term results of the two surgical procedures for the treatment of coronary heart disease with severe IMR were evaluated by comparing the perioperative data of the two groups,the echocardiographic results at the time of discharge and the last follow-up,and the incidence of postoperative complications.ResultsThere was no statistically significant difference in perioperative data between the two groups?p>0.05?,among which 3 patients died during perioperative period in MVP group and 2 patients died during perioperative period in MVR group.At the time of discharge,8 patients?18.6%?in MVP group had residual mitral regurgitation or mild regurgitation,but none in MVR group had regurgitation.LVEF?43.7±8.1?%in MVP group was significantly higher than that in MVR group?36.2±7.6?%,with statistical significance?p<0.05?.LVEDD between the two groups was compared,and there was no statistical significance?p>0.05?.Follow up?1.5⁵?year,There were 3 deaths and 1 loss in MVP group.In the MVR group,1 case died and 0 cases were lost to follow-up,Compared with the near and medium term survival rate of the two groups,and the difference were not statistically significant?p>0.05?.The last follow-up,in the MVP group,10 cases?25.6%?had residual or recurrent mild reflux and 6 cases?15.4%?had moderate reflux,in the MVR group,there were no reflux cases,differences have statistical significance?p<0.05?;LVEF and LVEDD of the two groups were compared,with no statistical significance?p>0.05?.In this study,13 patients in MVP group were hospitalized again,and 3 patients in MVR group were hospitalized again,and the difference was statistically significant?p<0.05?.There were no patients in the two groups who underwent secondary surgery,and one elderly patient in the MVR group was found to have perivalvular leakage by outpatient reexamination 3 months after surgery.Because the patient's family refused to perform secondary surgery and internal closure,conservative treatment with drugs was performed.ConclusionsThere is no statistically significant difference in the short-term and mid-term postoperative survival rates between the MVP group and the MVR group.Although the risk of postoperative residual or recurrent mitral valve regurgitation is higher in the MVP group,however,there were no patients in the two groups who underwent secondary surgery.Both surgical methods can improve postoperative left ventricular function and promote left ventricular reverse remodeling.The long-term effect still needs to be confirmed by further large data sample study.