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Objective:To summarize the clinical data of mitral valve surgery completed in a single surgical team in one year, to discuss the etiologic characteristics, methods, results and early postoperative outcomes of mitral valvuloplasty surgeries, and to analyze the epidemiologic trends of mitral valve diseases admitted to the hospital.Methods:A total of 209 mitral valve surgeries completed by the same surgeon in the single surgical team at the Cardiovascular Surgery, First Medical Center, Chinese PLA General Hospital, from January 2021 to December 2021 were retrospectively analyzed. Mitral valve surgery accounted for 53.6% of all surgeries in this team during the same period. There were 100 cases(47.8%) in males and 109 cases(52.2%) in females, aged 11-85 years old, with a mean of(53.5±15.2) years old. There were 121 cases(57.9%) of NYHA class Ⅱ and 88 cases(42.1%) of class Ⅲ/Ⅳ.Results:Of the 152 mitral valvuloplasty surgeries, 117(77%) were performed with a totally Thoracoscopic approach. Annuloplasty rings were applied in 145 cases(95.4%), including semi-rigid closed Physio II annuloplasty rings in 118 cases(81.4%), Gore-Tex artificial chordae were applied in 89 cases(58.6%) for a total of 145, leaflet repair in 15 cases(9.9%), edge-to-edge repair in 2 cases(1.3%), commissure suture in 34 cases(22.4%), and chordae tendineae and papillary muscle splitting in 15 cases(9.9%). The repair rate of degenerative mitral valve disease was 100%, and the repair rate of rheumatic mitral valve disease was 48.1%. The echocardiogram was received about one week after surgery, and there was no or trace regurgitation in 91 cases(59.9%), mild in 58 cases(38.2%), and moderate in 3 cases(2.0%). There were 2 cases(1.3%) of all-cause death.Conclusion:Degenerative mitral valve disease have become the leading cause of mitral valve disease in our center, and the proportion of rheumatic mitral valve disease has decreased. Degenerative mitral valve disease has a very high repair rate, and rheumatic mitral valve disease has a relatively low repair rate due to its special pathologic and anatomic characteristics. Most mitral valvuloplasty procedure can be performed in a totally thoracoscopic approach. The application of a mitral valvuloplasty ring combined with Gore-Tex artificial chordae by an experienced surgeon can achieve reliable repair results.
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Objective Mitral valve regurgitation often leads to cardiac insufficiency or even heart failure .Methods We tried a mitral valve annuloplasty with a ring to improve the effect of mitral valvuloplasty , 5 males and 6 females; aged(8.0 ± 4.5)years;weight(26.1 ±13.9)kg.From February 2015 to December 2017, 11 children underwent mitral valve annuloplasty with an mitral valve ring in our hospital.Immediately after surgery, the degree of mitral valve regurgitation was significant im-proved from moderate-severe to mild-moderate(P<0.05).Results 1 case of early death, 1 case had a mitral valve replace-ment because of early hemolysis.The rest of the children were discharged smoothly.The follow-up of 3 months of mitral valve regurgitation was not aggravated comparing with that immediately after surgery(P>0.05).There was no worsening of cardiac function at follow-up(P>0.05), and no other adverse events.Therefore, artificial mitral annuloplasty with a ring is effective in treating mitral regurgitation in children .The annulus had potential growth characteristics and did not require lifelong oral an-ticoagulant.Conclusion For some patients with difficulty, this method of mitral valvuloplasty can enlarge the surgical indica-tion and improve the quality of life of children.The treatment effect is good.
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Objective To compare the mid- and long-term results of tricuspid valve (TV) repair with or without an annuloplasty ring. Methods Two hundred seventy-seven patients underwent TV repair at our division (Sep. 2001 to Sep. 2008) ,of which 203 had, predominantly, a De Vega or Kay procedure (non-ring group) and 74had an annuloplasty with an artificial ring (ring group). TV pathology mainly was functional (secondary) and several with rheumatic leaflets involvement. Concomitant procedures consisted of mitral valve surgery in all patients,aortic valve surgery in 81 ,and coronary bypass in 19. Clinical and echocardiographic data followed for 1.5 to 3.5years were obtained. Results Postoperationally,the mid-term(1.5 years) follow-up was 100% completed and the long-term follow-up for 3. 5 years was 89. 9%. The recurrence of TV regurgitation (TR) of moderate and lower degree was not significantly different(χ2 = 1.3128, P= 0.26) in the 1.5 years follow-up between the two group,whereas the recurrence of TR of moderate to severity degree was significantly less in the ring group (χ2 =5. 8159,P =0.023).In the long term follow up,the TR in the ring group (25%) was significantly lower than that of 15% in the non-ring group (χ2 = 4. 9328, P = 0.036) . There are higher proportion of patients developing to moderate TR in the non ring group(34%) than in the ring group (10%) (χ2 =7. 9120,P =0.005). The TR developed fast in the ring group,increasing from 18% at 1.5 years follow up to 10% at 3.5 years follow up (χ2 = 2. 1327, P = 0.016),whereas it was relatively stable in the non-ring group,with 7% at 1.5 year follow up and 10% at 3.5 year follow up. Conclusions Placement of an annuloplasty ring in patients undergoing TV repair could remarkably improved the mid and long terum outcome. In clinic practice, we should be more positive to the functional TR and prefer to the procedure with annuloplasty ring.