Early Efficacy Of Mitral Valve Replacement In Ischemic Mitral Regurgitation

Objective: To evaluate the early clinical efficacy of mitral valve replacement for ischemic mitral regurgitation.To compare the effects of the retention of the posterior and subvalvular structures during mitral valve replacement on the improvement of left ventricular function in patients with ischemic mitral regurgitationMethods: Patients with moderate and severe ischemic mitral regurgitation who received mitral valve replacement combined with coronary artery bypass grafting in the cardiac surgery department of our hospital from January 2015 to October 2019 were selected.According to whether the posterior and subpetal structures were preserved during mitral valve replacement,the subjects were divided into the reserved group and the non-reserved group.Postoperative followup was conducted for 3 months to compare the operation situation,postoperative complications,preoperative and postoperative echocardiography results of the two groups,and to analyze the early clinical efficacy of the operation.Results: A total of 44 patients were included in the study,including 25 patients in the reserved group and 19 patients in the non-reserved group.All the subjects were moderate or severe mitral regurgitation,and there was no statistically significant difference in preoperative clinical data between the two groups.All subjects underwent mitral valve replacement combined with coronary artery bypass grafting successfully,and there were 0 cases of death during the perioperative period.In the retention group,2 cases required intra-aortic balloon contralateral pulsation support after surgery,1 case had new cerebral infarction after surgery,and 1 case had multiple secondary operations for thoracotomy for hemostasis due to postoperative drainage volume.During the 3-month follow-up period,there were no deaths,and 1 patient in the non-reservation group was readmitted to hospital for heart failure 2 months after surgery,and the clinical symptoms of all patients were significantly improved compared with those before surgery 3 months after surgery.The extracorporeal circulation time in the retention group(173.4±50.3min)was longer than that in the non-retention group(133.6±27.2min)(P < 0.01).In addition,the number of CABG Bridges in the retained group(2.2±0.8)was higher than that in the non-retained group(1.6±0.9)(P=0.01).There were no statistically significant differences between the two groups in terms of ascending aorta occlusion time,intra-aortic balloon contraption support,ventilator use time,CSICU residence time,second thoracotomy for hemostasis,drainage volume on day 1 and day 2 postoperatively,and postoperative complications.In the same group of patients,3 months after surgery,compared with preoperative echocardiography,left ventricular end-diastolic diameter,left ventricular end-systolic diameter and mitral regurgitation were significantly reduced compared with those before surgery,but there was no significant difference in left ventricular ejection fraction compared with that before surgery.In contrast echocardiography 3 months after surgery,there was no significant difference between left ventricular end-diastolic diameter,left ventricular end-systolic diameter,mitral regurgitation and left ventricular ejection fraction.Conclusion: Mitral valve replacement is safe and feasible for moderate or severe ischemic mitral regurgitation and has good early clinical efficacy.In patients with moderate or severe ischemic mitral regurgitation,retention of the posterior and subvalvular structures during mitral valve replacement had an improvement in early postoperative left ventricular function,but there was no significant advantage in early postoperative improvement compared with no retention.