Clinical Effects Analysis Of Mitral Vavle Replacement And Mitral Valvuloplasty In The Patients With Mitral Insufficiency

Objective:To investigate the clinical effect and medium-term prognosis of mitral valve replacement and mitral valvuloplasty in patients with mitral insufficiency by retrospective analysis.Method:In this study,patients who underwent mitral valve replacement or mitral valvuloplasty for mitral valve insufficiency from January 1,2016 to May 31,2019 were enrolled in the department of cardiovascular surgery of Yijishan hospital of Wannan Medical College.Perioperative parameters and follower-up data of 1 week,1month,3 month,6 month were analyzed.When the patients were admitted to hospital,relevant parameters was recorded,parameters of pre-operation :Weight,age,blood pressure;Left atrial diameter(LAD),left ventricular end-diastolic diameter(LVEDd),ejection fraction(EF),cardiac functional grade,and left ventricular shortening(FS);During operation: operation time,extracorporeal circulation time,aortic cross-clamp time;drainage volume after the operation;The patients were followed up for six months and more,the data of left LAD,EF,cardiac functional grade and other cardiac parameters of the patients were recorded 1 week,1 month,3 months and 6 months after the operation,and the postoperative complications of the patients were enrolled.we will understand the treatment and prognosis of mitral valve replacement and mitral valvuloplasty in patients with mitral valve insufficiency by comparing data of preoperative,intraoperative and postoperative follow-up for six months and more.Result:A total of 154 patients were enrolled in the study,including 98 patients who underwent mitral valve replacement and 56 patients who underwent mitral valvuloplasty.The replacement group lost 5 patients during follow-up(5.10%),and the valvuloplasty group lost 12 patients during follow-up(21.43%).A total of 137 patients completed follow-up,none of them died during the follow-up period.In the replacement group,there were 2 patients of postoperative delayed healing,1 patient of low cardiac output,2 patients of thromboembolism(1 patient of stroke,1 patient of thrombus of lower extremity veins),3 patients of bleeding(2 patients of petechia,1 patient of ecchymosis),and 1 patient of postoperative wire removal surgery.In the valvuloplasty group,there was 1 patient of postoperative delayed healing,1 patient of petechia,1 patient of postoperative wire removal surgery.During the six months of follow-up,LAD,LVEDd,FS and cardiac functional grade of patients in the two groups were significantly improved,with statistically significant difference compared with preoperative parameters(P<0.05);EF was improved at one week after surgery,but there was no statistically significant difference compared with preoperative parameters(P>0.05),and there was a statistically significant difference after one month of follow-up(P<0.05).Conclusion:Mitral valve replacement and mitral valvuloplasty have obvious clinical effect for the treatment of mitral insufficiency.Both surgerical ways can distinctly improve the cardiac ejection function and diastolic function;The left atrium and left ventricle of patients in both groups were significantly reduced.During the medium-term follow-up,the patients of relative postoperative complication of the group of mitral valve replacement were more than the group of mitral valvuloplasty,and the rate of non-anticoagulation-related complications was similar between the two groups,and the rate of anticoagulation-related complications in the replacement group was significantly higher than that in the valvuloplasty group.