Clinical analysis of concomitant valve replacement and bipolar radiofrequency ablation in 191 patients.

OBJECTIVE: The study objective was to evaluate the safety and efficacy of concomitant bipolar radiofrequency ablation and heart valve replacement in patients with rheumatic heart disease and atrial fibrillation. METHODS: A total of 191 patients with rheumatic heart disease and chronic atrial fibrillation underwent valve replacement with concomitant bipolar radiofrequency ablation. There were 78 male and 113 female patients with a mean age of 46.0 ± 9.1 years and an atrial fibrillation duration of 43.7 ± 15.4 months. Valve replacement surgery included mitral valve replacement in 121 patients, mitral and aortic valve replacement in 59 patients, mitral and tricuspid valve replacement in 8 patients, and triple valve replacement in 3 patients. All patients received oral antiarrhythmic drugs for 3 to 6 months postoperatively. Follow-up electrocardiography and color Doppler echocardiography were performed postoperatively. RESULTS: The mean aortic crossclamping time was 84.0 ± 25.5 minutes, and cardiopulmonary bypass time was 139.4 ± 39.1 minutes. There was no abnormal bleeding due to bipolar radiofrequency ablation. Three patients (1.57%) died of low cardiac output syndrome in hospital at 2, 3, and 5 days after surgery. Major perioperative complications include reoperation for bleeding (n = 1), reoperation for wound infection (n = 1), intra-aortic balloon pump placement (n = 2), and renal failure (n = 2). All other patients were discharged without complications. The mean follow-up time was 17.4 ± 11.8 months with a follow-up rate of 95.3%. There were no cases of late death, complete atrioventricular block, or anticoagulation-induced complications. Of 158 patients who were followed up for 1 year, sinus rhythm was maintained in 125 (79.11%). CONCLUSIONS: Concomitant bipolar radiofrequency ablation is an effective and safe technique for treating atrial fibrillation in patients with rheumatic heart disease undergoing valve replacement, with promising follow-up results.

[Impact of tricuspid annuloplasty on changes of right atrioventricular diameter and annulus in patients with mitral valve replacement].

OBJECTIVE: To observe changes of right atrioventricular diameter and annulus after mitral valve replacement (MVR) in patients with and without tricuspid annuloplasty. METHODS: A total of 112 patients who underwent MVR surgery from April 2005 to December 2006 were recruited in this study. The patients were divided into two groups. Those with maximal tricuspid annulus diameter/body surface area > or = 21 mm/m2 were given tricuspid annuloplasty (TAPG, n=56). Otherwise, no tricuspid annuloplasty were performed (NTAPG, n=56). All of the patients were followed up regularly. The echocardiography were reviewed two years after the surgery. RESULTS: An average of (25.04 +/- 5.04) months had passed when the echocardiography were reviewed. The two groups had no differences in age, gender, body surface areas and cardiac functions (P>0.05). The TVPG group had more patients with atrial fibrillation than the NTVPG group (P<0.05). In the patients in the TVPG group, the right atrioventricular diameter, and maximal and minimal tricuspid annulus diameter were significantly narrowed after the operations (P<0.05). The percent shorting of tricuspid valve annulus did not change significantly (P> 0.05). The constituent ratio of TR was significantly reduced (P<0.05). However, in the patients in the NTVPG group, the right atrioventricular diameter did not change significantly (P>0.05). The maximal and minimal tricuspid annulus diameter increased (P<0.05). The percent shorting of tricuspid valve annulus did not change significantly (P>0.05). Though the constituent ratio of TR had no significant changes, 5 (13.5%) patients developed moderate or serious TR two years after the operations. CONCLUSION: Tricuspid annuloplasty (TAP) has benefits for the patients with enlarged right atrioventricular and tricuspid annulus. For those patients without enlarged right atrioventricular and tricuspid, their tricuspid valve conditions should also be carefully assessed. Because as time lapse, these patients may also develop TR.

[Doppler echocardiographic assessment of CarboMedics prosthesis in patients with mitral valve replacement].

OBJECTIVE: To evaluate the CarboMedics (CM) prosthesis function two years after mitral valve replacement, and to compare the effective orifice area (EOA) calculated by pressure half-time (PHT) method and continuity method (CON). METHODS: Forty nine patients who underwent isolated mitral valve replacement with a CM prosthesis were recruited in this study, which included 13 cases of 25 mm CM prosthesis and 36 cases of 27 mm CM prosthesis. Two years after the mitral valve replacement, transthoracic echocardiography (TTE) was performed, measuring left ventricular ejection fraction (LVEF), stroke volume mean gradient (SV), PHT, peak early mitral diastolic velocity (E velocity), mean gradient (MG), time-velocity integral of left ventricular outflow tract/time-velocity integral of mitral valve prosthesis (TVI(MVP)/TVI(LVOT)). The function of the prosthetic valve was considered normal when PHT < 130 ms, E velocity < 2.0 m/s and TVI(MVP)/TVI(LVOT) < 2.2. RESULTS: More than half (53.1%) of the patients had normal function of the prosthetic valve. No significant differences were found in PHT, MG, TVI(MVP)/TVI(LVOT), EOA or IEOA between the patients with 25 mm valve and the patients with 27 mm valve (P > 0.05). But the patients with 25 mm valve had higher E velocity than the patients with 27 mm valve (P < 0.05). The PHT method produced greater EOA than by the CON method (P < 0.05). CONCLUSION: The function of CM prosthesis is acceptable two years after the mitral valve replacement, with most patients having PHT < 130 ms, E velocity < 2.0 m/s and TVI(MVP)/TVI(LVOT) < 2.2. PHT method produces greater EOA than CON method.

[Tricuspid valve replacement and anticoagulation therapy: a report of 70 cases].

OBJECTIVE: To evaluate the operative indication, the choice of valve prostheses, and the method of anticoagulation therapy of tricuspid valve replacement (TVR). METHODS: From May 1998 to January 2008, 70 patients underwent TVR. There were 59 cases of rheumatic heart diseases. The operations included mitral and tricuspid valve replacement for 37 cases, triple valve replacement for 18 cases, isolated TVR for 13 cases, and tricuspid and aortic valve replacement for 2 cases. All the patients received oral anticoagulant therapy (warfarin) 2 d after the operations. RESULTS: There were 3 in-hospital deaths (4.3%) and 1 late death (0.4%). The follow-up rate was 88.1%, and the cumulative follow-up was 243.5 patient-years (pty). The anticoagulation-related event rate was 2.9% pty, and the mean INR value of 643 out-patient samples was 1.87 +/- 0.68. Post-operative heart function NYHA classification: 52 cases in class I to II, and 7 cases in class III. CONCLUSIONS: TVR should be indicated for severely damaged and deformed tricuspid valve of rheumatic heart diseases. Bileaflet mechanical valve is a suitable prosthesis for TVR. The optimal anticoagulation therapy intensity of TVR needs to be investigated.