Early and mid-term postoperative comparison of left ventricular structure and function between the mitral repair and replacement in patients with mitral regurgitation / 中华胸心血管外科杂志

Objective@#To compare the early and mid-term postoperative changes of left ventricular structure and function beteen mitral repair and replacement in patients with mitral regurgitation.@*Methods@#100 patients with degenerative mitral regurgitation underwent mitral valve replacement and mitral repair from January 2008 to January 2018 were retrospectively studyed. Of them, 46 patients underwent mitral repair and(repair group) 54 patients underwent mitral valve replacement(replacement group). The results of color Doppler echocardiography before, one week after, 12 months after and 24-36 months after operation were collected. Left atrial diameter(LAD), left ventricular end diastolic diameter(LVEDD) and left ventricular end systolic diameter(LVESD) were selected to evaluate left ventricular structure, fraction shortening(FS)、left ventricular stroke volume( SV )and left ventricular ejection fraction(LVEF) to evaluate left ventricular function. The data were analyzed by SPSS 22.0.@*Results@#In left ventricular structural parameters, LAD, LVEDD and LVESD in mitral repair group and replacement group were significantly improved compared with those before operation(P<0.05). There was no significant difference in LAD, LVEDD and LVESD between the two groups at 12 months after operation(P>0.05). There were significant differences in LAD(42.26 mm vs 47.15 mm), LVEDD(52.97 mm vs 60.18 mm) and LVESD(31.34 mm vs 34.82 mm) between the two groups at 24-36 months of follow-up(P<0.05). Among the left ventricular function indicators, the early and mid-term SV of the two groups were significantly improved compared with that of the preoperative group(P<0.05). LVEF(0.64 vs 0.59、0.64 vs 0.58)was significantly improved in the 12 and 24-36 months after the operation, and FS(36.18% vs 31.47%) was significantly different in the 24-36 months after the operation(P<0.05).@*Conclusion@#Mitral repair has high technical requirements and long operation time, but it has obvious advantages over mitral valve replacement in maintaining left ventricular structure and function in the middle and late period after operation.

Early and mid-term postoperative comparison of left ventricular structure and function between the mitral repair and replacement in patients with mitral regurgitation / 中华胸心血管外科杂志

Objective To compare the early and mid-term postoperative changes of left ventricular structure and function beteen mitral repair and replacement in patients with mitral regurgitation. Methods 100 patients with degenerative mitral re-gurgitation underwent mitral valve replacement and mitral repair from January 2008 to January 2018 were retrospectively stud-yed. Of them, 46 patients underwent mitral repair and(repair group) 54 patients underwent mitral valve replacement(replace-ment group) . The results of color Doppler echocardiography before, one week after, 12 months after and 24-36 months after operation were collected. Left atrial diameter( LAD) , left ventricular end diastolic diameter( LVEDD) and left ventricular end systolic diameter(LVESD) were selected to evaluate left ventricular structure, fraction shortening(FS)、left ventricular stroke volume( SV )and left ventricular ejection fraction(LVEF) to evaluate left ventricular function. The data were analyzed by SPSS 22. 0. Results In left ventricular structural parameters, LAD, LVEDD and LVESD in mitral repair group and replace-ment group were significantly improved compared with those before operation(P<0. 05). There was no significant difference in LAD, LVEDD and LVESD between the two groups at 12 months after operation(P>0. 05). There were significant differences in LAD(42. 26 mm vs 47. 15 mm), LVEDD(52. 97 mm vs 60. 18 mm) and LVESD(31. 34 mm vs 34. 82 mm) between the two groups at 24-36 months of follow-up(P<0. 05). Among the left ventricular function indicators, the early and mid-term SV of the two groups were significantly improved compared with that of the preoperative group(P<0. 05). LVEF(0. 64 vs 0. 59、0. 64 vs 0. 58)was significantly improved in the 12 and 24-36 months after the operation, and FS(36. 18％ vs 31. 47％) was significantly different in the 24-36 months after the operation(P<0. 05). Conclusion Mitral repair has high technical requirements and long operation time, but it has obvious advantages over mitral valve replacement in maintaining left ventricular structure and function in the middle and late period after operation.

La cirugía mínimamente invasiva de la válvula mitral a través de toracotomía derecha es un procedimientoseguro y eficaz a corto y largo plazo. Estudio de cohortes ajustadas por nivelación del riesgo de propensión / Minimally-invasive mitral valve surgery via right thoracotomy is a safe an efficient procedure in the short and long term. Cohort study adjusted by propensity score matching

Resumen Introducción: La cirugía cardiaca mínimamente invasiva sobre la válvula mitral ha crecido en popularidad. El objetivo del estudio es valorar la morbilidad y eficacia de la técnica a medio plazo en una serie inicial. Material y métodos: 212 pacientes fueron sometidos a cirugía sobre la válvula mitral entre los años 2009 y 2013; 44 mediante cirugía mínimamente invasiva por toracotomía y 168 por esternotomía media. Se realizó un emparejamiento estadístico para la obtención del grupo control por regresión logística y nivelación del grado de propensión considerando las principales variables de riesgo. Se registró la morbilidad y calidad de la reparación o sustitución. Se realizó un análisis univariante y multivariante para un evento compuesto de morbimortalidad, eficacia y requerimientos de hemoderivados. Resultados: Fueron incluidos 44 pacientes por grupo. La media de seguimiento fue de 26,6 (14,6) y 28,4 (1,1) meses en el grupo de estudio y control, respectivamente. Se realizó reparación de la válvula mitral en el 70,5% en el grupo estudio y en el 68,2% en el grupo control. No se encontraron diferencias en la morbimortalidad perioperatoria. El número de pacientes que desarrollaron insuficiencia mitral moderada o severa durante el seguimiento fue del 9,1% en el grupo estudio y 11,4% en el control (p = 1,0). Tanto en el análisis univariante como multivariante la cirugía mínimamente invasiva fue un predictor independiente de menor transfusión. Conclusión: La cirugía mínimamente invasiva no es inferior a la esternotomía en morbilidad hospitalaria, ni en la calidad de la técnica quirúrgica en un programa de iniciación.

Abstract Introduction: Minimally-invasive mitral valve cardiac surgery has become increasingly popular. The objective of this study is to assess morbidity and efficiency of the technique in the médium run in an initial series. Material and methods: 212 patients underwent mitral valve surgery between 2009 and 2013; 44 with minimally-invasive thoracotomy and 168 via median sternotomy. Statistical pairing was conducted to obtain the control group by means of logistic regression and propensity score matching considering the main risk variables. Morbidity and repair or replacement quality were registered. A univariate and multivariate analysis was carried out for an event comprising morbidity and mortality, efficiency and blood component requirements. Results: Each group included 44 patients. Average follow-up time was 26.6 (14.6) and 28.4 (1.1) months in the study group and control group respectively. Mitral valve repair was performed in 70.5% of patients in the study group and in 68.2% of patients in the control group. No differences were found in perioperative morbidity and mortality. The number of patients who developed moderate or severe mitral insufficiency during follow-up was 9.1% in the study group and 11.4% in the control group (p = 1.0). Minimally-invasive surgery was an independent predictor for lower transfusion in both the univariate and multivariate analyses. Conclusion: Minimally-invasive surgery is not inferior to sternotomy in hospital morbidity or in the quality of surgical technique in an initial program.

The three dimensional annulus configuration changes after application of two dimensional artificial mitral annuloplasty / 中华胸心血管外科杂志

Objective To investigate the mitral annular three dimensional configuration changes after application of two dimensional mitral annuloplasty.Methods Includes criteria:serious mitral prolapse without other cardiac disorders,with age ranged from 18 to 60 years old.Three dimensional echocardiography was performed before the surgery in the operation room.The mitral annular three dimensional configuration,the mitral prolapse and regurgitation grades were examined.And same procedure was done after the mitral repair.All the measure results were expressed as x ± s and the statistical analysis was performed using SPSS 19.0 software.Results Totally 42 cases were enrolled,including 28 posterior prolapse and 14 anterior prolapse cases.All the mitral repair got satisfied none or mild regurgitation.The mitral annulus moved consistently as saddle shape during the whole cardiac cycle,the lowest annulus part was at the commissure and the highest part was at the anterior and posterior annulus centers.During the systolic phase the non-planer angel between anterior and posterior annuls was bigger than in diastolic phase.The annulus circumference,transverse,longitudinal diameters decreased compared with before the surgery.Preoperative mitral transverse diameter and longitudinal diameter values are almost the equal size,indicating the mitral annulus was in nearly round shape.However the longitudinal/transverse ratio reached 0.88 after surgery which implied the annulus configuration recovery after annuloplasty.After the mitral annuloplasty the annular height decreased from (8.4 ± 0.6) mm to (3.2 ±0.1) mm while the annular height/transverse diameter ratio decreased from 0.24 to 0.15,which may be affected by the application of the two dimensional rigid artificial annulus.Non-planar angle between the anterior and posterior mitral annuls increased from(136 ± 13)degrees to(145 ± 14) degrees after mitral repair.Conclusion The mitral annulus configuration may have planarization changes due 1o the apply of two dimentional artificial annulus.

Clinical Use of Doppler Echocardiography in Organic Mitral Regurgitation: From Diagnosis to Patients' Management

Knowledge of mitral regurgitation (MR) is essential for any care provider, and not only for those directly involved in the management of cardiovascular diseases. This happens because MR is the most frequent valvular lesion in North America and the second most common form of valve disease requiring surgery in Europe. Furthermore, due to the ageing of the general population and the reduced mortality from acute cardiovascular events, the prevalence of MR is expected to increase further. Doppler echocardiography is essential both for the diagnosis and the clinical management of MR. In the present article, we sought to provide a practical step-by-step approach to help either performing a Doppler echocardiography or interpreting its findings in light of contemporary knowledge on organic (but not only) MR.

Validation of a decision-making strategy for systolic anterior motion following mitral valve repair.

Low cardiac output syndrome and hypotension are dreadful consequences of systolic anterior motion (SAM) after a mitral valve (MV) repair. The management of SAM in the operating room remains controversial. We validate a recently suggested two-step management method and classification of this complication. This was a teaching hospital-based observational study. We validated a novel two-step conservative management method, consisting in intravascular volume expansion and discontinuation of inotropic drugs (step 1), and increasing the afterload by ascending aorta manual compression while administering esmolol e.v. (step 2). We also validate a novel classification of SAM: easy-to-revert (responding to step 1), difficult-to-revert (responding to step 2), or persistent. Fifty patients had an easy-to-revert while 26 had a difficult-to-revert SAM; 4 patients had a persistent condition (promptly diagnosed through our decisional algorithm) and underwent an immediate second pump run to repeat the mitral repair surgery. We confirmed that SAM after a repair of a degenerative MV is common and validated a simple two-step conservative management method that allows to clearly identify those few patients who require immediate surgical revision.