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INTRODUCTION: No previous studies comparing the outcomes between off-pump coronary artery bypass grafting (off-pump CABG, OPCAB) and on-pump CABG (ONCAB) have been performed in patients with severe left ventricular dysfunction (LVD) and a giant left ventricle. We aimed to investigate whether such patients could benefit from OPCAB. METHODS: From January 2011 to January 2021, a total of 98 patients with severe LVD and a giant left ventricle underwent isolated CABG (ONCAB 46, OPCAB 52) in Wuhan Union Hospital. The clinical data were collected retrospectively and propensity score matching was performed to adjust baseline characteristics. RESULTS: After propensity matching, the two groups were comparable in baseline variables. The OPCAB group had a higher rate of incomplete revascularization than the ONCAB group (25.0% vs. 9.1%; p = 0.047). The 30-day mortality was similar between the matched groups (4.5% vs. 4.5%; p = 1.000) but the OPCAB group had a lower risk of postoperative IABP usage (9.1% vs. 25.0%; p = 0.047) and renal insufficiency (11.4% vs. 29.5%; p = 0.034). The long-term probability of survival (log-rank test, p = 0.450) was similar between the two groups but the OPCAB group had a lower probability of major adverse cardiovascular events (log-rank test, p = 0.038). CONCLUSIONS: For patients with severe LVD and a giant left ventricle, OPCAB reduced early postoperative complications while sacrificing long-term quality of life compared to those having ONCAB.
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@#Due to the abnormal structure and function of the cardiac valves, cardiac valve disease gradually appears the expansion of left ventricular inner diameter and volume. When the left ventricular end-diastolic dimension and volume expand severely, it becomes a giant left ventricle. Surgical valve replacement is still one of the main treatment methods for this disease. The degree of postoperative ventricular recovery is closely related to perioperative mortality and long-term prognosis. However, the existing clinical preoperative assessment methods still cannot accurately predict the degree of postoperative left ventricular recovery and long-term prognosis of such patients, so it is difficult to determine the optimal operation timing and surgical methods for patients. Therefore, we reviewed the existing literature and discussed different evaluation methods of the giant left ventricle associated with valvular disease before surgery, so as to optimize the perioperative treatment of such patients, clarify the timing of surgery and improve the prognosis.
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PURPOSE: To analyze the efficacy of minimally invasive beating heart technique for mitral valve surgery in the cardiac patients with previous sternotomy and giant left ventricle. METHODS: Eighty cardiac patients with previous sternotomy and giant left ventricle according to the diagnostic criteria that left ventricular end diastolic diameter (LVEDD) was ≥70 mm, who underwent mitral valve surgery at our center from January 2006 to January 2019 were analyzed. We divided all patients into minimally invasive beating heart technique group (n = 30) and conventional median resternotomy arrested heart technique group (n = 50) according to the surgical methods. Preoperative, intraoperative, and postoperative variables were compared between two groups. RESULTS: Minimally invasive beating heart technique compared to the conventional median resternotomy arrested heart technique for mitral valve surgery in the cardiac patients with previous sternotomy and giant left ventricle had significant differences in operation time(P = 0.002), cardiopulmonary bypass (CPB) time(P < 0.001), intraoperative blood loss(P < 0.001), postoperative transfusion ratio(P = 0.01), postoperative transfusion amount(P < 0.001), postoperative drainage volume(P = 0.001), extubation time(P = 0.04), intensive care unit (ICU) stay time(P = 0.04) and postoperative hospital stay time(P < 0.001), but no significant differences in re-exploration for bleeding, postoperative 30-day mortality, postoperative complications and 6 months postoperative echocardiographic parameters. CONCLUSIONS: Using the method of minimally invasive beating heart technique for mitral valve surgery in the cardiac patients with previous sternotomy and giant left ventricle is effective and reliable, meanwhile reduce the operation time and CPB time, decrease the transfusion ratio and transfusion amount, shorten postoperative ICU stay and hospital stay time, promote the early extubation so that accelerate the patients' early recovery. All of these show a benefit of minimally invasive beating heart technique compared to conventional median resternotomy arrested heart technique.
Subject(s)
Heart Valve Diseases/surgery , Heart Valve Prosthesis Implantation/methods , Minimally Invasive Surgical Procedures/methods , Mitral Valve Annuloplasty/methods , Mitral Valve/surgery , Aged , Blood Loss, Surgical , Blood Transfusion , Cardiac Surgical Procedures/methods , Cardiac Valve Annuloplasty/methods , Female , Heart Ventricles , Humans , Intensive Care Units , Length of Stay , Male , Middle Aged , Operative Time , Postoperative Complications/epidemiology , Sternotomy/methods , Tricuspid Valve/surgeryABSTRACT
Objective Giant left ventricle indicates severe or irreversible pathologic injury of the cadiocytes in the left ventricle.This study was to investigate the effects of cardiac valve replacement on the volume of the left ventricle and systolic function of the heart.Methods We retrospectively analyzed the clinical data about 41 cases of cardiac valve replacement for giant left ventricle (left ventricle end diastolic dimension LVEDD ≥ 70 mm and left ventricle end systolic dimension LVESD ≥ 50 mm).We compared the LVEDD,LVESD and left ventricular ejection fraction (LVEF) of the patients before and at 1 week,3 months and 1 year after operation.Results Compared with the baseline,LVEDD and LVESD were decreased significantly at 1 week,3 months and 1 year after operation in a timedependent manner (P＜0.01),while LVEF reduced at 1 week (P＜0.01),restored to the preoperative level at 3 months (P=0.10),and increased at 1 year postoperatively (P＜0.05).Based on the New York Heart Association (NYHA) functional classification,there were 16 cases of class Ⅱ,22 cases of class Ⅲ,1 case of class Ⅲ-Ⅳ,and 2 cases of class Ⅳ preoperatively.Follow-up was completed in 36 cases (87.8％),with a mean time of 50.03± 19.28 (12-95) months,during which 34 (94.4％) of the patients survived,including 24 cases of NYHA class Ⅰ and 10 cases of class Ⅱ,and 2 (5.6％) died,1 from chronic cardiac failure complicated by multiple organ failure and the other from liver cancer with systemic metastasis.Five (12.2％) of the cases were lost to follow up.Conclusion Cardiac valve replacement decreases the left ventricular volume of the patient with giant left ventricle in a time-dependent manner.The systolic function of the heart is reduced in the early postoperative period,which,however,may gradually improve with time and become better than the preoperative status.
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Objective To explore the effect of cardiac valve replacement surgery in the medium term on patients with giant left ventricular and its related risk factors.Methods Retrospective analysis the clinical data of 82 cases of valvular heart disease with giant left ventricle underwent heart valve replacement surgery.To compare the size and function of heart between preoperation and postoperation,and explore the relevant risk factors affecting the prognosis.Results The left atrial diameter,left ventricular end diastolic diameter,and left ventricular systolic diameter (LVESD) were decreased after the operation,and the difference was statistically significant (P ＜ 0.05).There was no significant difference between left ventricular ejection fraction and left ventricular shortening rate.But the NYHA classification showed significant difference (P ＜ 0.05).The risk factors related to the prognosis of patients were preoperative LVESD value ＞6.0 cm,heart function NYHA classification in grade Ⅳ,postoperative unuse of ACEI drugs or β-blockers (P ＜ 0.05).Conclusion The perioperative mortality is low in patients with valvular heart disease and giant left ventricle after heart valve replacement surgery.The curative effect is satisfactory,the shape and size of the heart in the medium term have obvious reverse remodeling process,and the cardiac function is also improved.Preoperative LVESD value ＞6.0 cm,heart function NYHA classification in grade Ⅳ,postoperative unuse of ACEI drugs or β-blockers are the major risk factors affecting prognosis of patients.
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Objective: To analyze the incidence of functional mitral regurgitation (FMR),post-operation characteristics and operation indications of Marfan patients with severe aortic regurgitation and giant left ventricle. Methods: The clinical data and the follow-up data of 19 Marfan patients with severe aortic regurgitation (≥10 ml) and giant left ventricle (LVEDd≥7.0 cm), who were treated from Jan. 2000 to Dec. 2007,were analyzed retrospectively. Results: All patients received Bentall operation and there was no perioperation death. Follow-up was 72 patient-year (ranging 3 months-7 years). The degree of FMR decreased obviously after operation, with an improvement rate of 87.5%, and the FMR almost disappeared 6 months to 1 year later. Conclusion: Bentall achieves good outcome in Marfan patients with severe aortic regurgitation and giant left ventricle. Mild to moderate FMR(< 10 ml) disappears with the decrease of the left ventricle size. For patients with severe FMR (≥ 10 ml) complicated with dysfunction of left ventricle, managed ventricular pacing is suggested.
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Objective: Giant left ventricle is one of the important dangerous factors impacting the results of valve replacement operation.In order to improve the efficiency of operation,we summarized our experience in valve replacement surgery for patients with giant left ventricle(LVEDD ≥ 7.0 cm).Methods: We retrospectively analyzed the clinical data of 138 cases of giant left ventricle treated by valve replacement operation in our hospital from June 1996 to April 2008.The preoperative left ventricular end diastolic dimension(LVEDD),left ventricle end systolic dimension(LVESD),left ventricular ejection fraction(LVEF) and left ventricular fractional shortening(LVFS) were 7.38-10.51 cm(mean 7.98?0.39),5.20-7.93(mean 5.88 ? 1.03),0.21-0.66(mean 0.43 ? 0.11) and 0.10-0.45(mean 0.25 ? 0.07),respectively.Eighty-nine of the patients had the heart function(NYHA) of class Ⅲ,and the other 49 class Ⅳ.Mitral valve replacement(MVR) was performed for 57 cases,aortic valve replacement(AVR) for 26,double valves replacement(DVR) for 40,and Bentall operation for the other 15.Meanwhile,78 of them underwent tricuspid valve plasty(TVP),and another 17(LVEDD ≥8.5 cm and LVEF ≤ 25%) partial left ventriculectomy(PLV).Results: The early postoperative mortality rate was 5.8%,mainly due to postoperative multiple organ failure,severe low cardiac output syndrome and ventricular fibrillation.Compared with the preoperative data,postoperative echocardiography showed that LVEDD and LVESD were decreased slowly at 2 weeks,and LVEF and LVFS significantly improved at 6 months.In the 17 patients who underwent PLV,LVEDD and LVESD were significantly reduced at 2 weeks,and LVEF and LVFS markedly improved.Conclusion:The key to the efficiency of valve replacement for giant left ventricle was proper choice of the blood containing stop-beating fluid during the operation,preserving the posterior valve of the mitral valve and the structure beneath it,shortening aortic cross-clamping time as much as possible,and perioperative prevention and management of arrhythmia.The short-term effect of valve replacement with simultaneous PLV is satisfactory,while its long-term effect is yet to be further investigated.
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Objective To investigate the morphological and functional changes in the heart of patients with giant left ventricle after valve surgery,and to explore the relationship between the morphology of left ventricle and its function.Methods 86 patients with severely dilated left ventricle underwent echocardiographic examination before and 7-14 days after operation.Left ventricle diameters were measured(LVEDD,LVESD)and matched to the body surface area(LVEDDI,LVESDI).Left ventricular ejection fraction(EF)and fractional shortening(FS)were calculated.Results Left ventricular dimensions significantly decreased 7-14 days after operation.LVEDD was 76.48?5.21mm before operation and 62.58?12.62mm after operation(P