Efficacies of mitral valvuloplasty and mitral valve replacement on rheumatic mitral valve disease
Objective To explore the efficacies and safeties of mitral valvuloplasty(MVP)and mitral valve replacement(MVR)in the treatment of rheumatic mitral valve disease.Methods Totally 225 patients with rheumatic mitral valve disease were treated in the First Affiliated Hospital of Zhengzhou University from January 2020 to December 2022,and were divided into the MVP group(n=89)and the MVR group(n=136)according to the surgical methods.The surgery time,cardiopulmonary bypass time,aortic occlusion time,length of postsurgical hospital stay and perisurgical mortality were compared between two groups.Transthoracic echocardiography was performed before surgery,and 1 week and 6 months after surgery.The left atrial end-systolic dimension(LAESD),left ventricular end-diastolic dimension(LVEDD),left ventricular ejection fraction(LVEF),and mitral valve orifice area were compared between two groups.Mitral regurgitation was observed 6 months after surgery in two groups.Results The surgery time[(290.96±84.00)min],cardiopulmonary bypass time[(142.98±58.00)min]and aortic occlusion time[(101.57±43.00)min]in the MVP group were longer than those in the MVR group[(220.43±78.00),(105.34±49.00),(74.83±42.00)min](t=6.372,P＜0.001;t=5.206,P＜0.001;t=4.582,P＜0.001),and the length of postsurgical hospital stay was shorter in the MVP group[(12.25±4.80)d]than that in the MVR group[(14.19±5.80)d](t=2.612,P=0.010).There was no significant difference in the perisurgical mortality between the MVP group(1.1％)and the MVR group(5.1％)(x2=2.791,P=0.095).Six months after surgery,the LVEF was higher in the MVP group[(61.87±4.64)％]than that in the MVR group[(60.44±4.44)％](P＜0.05),the LAESD was shorter in the MVP group[(40.10±8.61)mm]than that in the MVR group[(42.46±6.26)mm](P＜0.05),and there were no significant differences in the LVEDD and mitral valve orifice area between the MVP group[(43.88±6.26)mm,(2.64±0.79)cm2]and the MVR group[(44.49±5.13)mm,(2.59±0.49)cm2](P＞0.05).Before surgery and 1 week after surgery,there were no significant differences in the LVEFs,LVEDDs,LAESDs and mitral valve orifice areas between the MVP group[(61.69±4.91)％,(61.20±5.54)％;(45.98±7.47),(44.25±6.45)mm;(50.61±9.21),(40.29±7.40)mm;(1.19±0.48),(2.52±0.78)cm2]and the MVR group[(60.88±4.21)％,(59.94±5.91)％;(47.61±7.65),(45.01±6.01)mm;(53.06±10.40),(41.72±6.74)mm;(1.11±0.52),(2.80±0.64)cm2](P＞0.05).Before surgery,1 week after surgery,and 6 months after surgery,the LVEDDs,LAESDs and mitral valve orifice areas showed significant differences in both two groups(F=11.521-788.195,all P values＜0.05),and the LVEFs showed no significant difference(F=1.266,P=0.284;F=2.113,P=0.123).The LVEDDs and LAESDs 1 week and 6 months after surgery were shorter than those before surgery(P＜0.05),the mitral valve orifice areas 1 week and 6 months after surgery were larger than that before surgery(P＜0.05).Six months after surgery,mild mitral regurgitation developed in 2 cases in the MVP group and 1 case in the MVR group,and no moderate or severe mitral regurgitation occurred.There was no significant difference in the incidence of mitral regurgitation between the MVP group(2.2％)and the MVR group(0.7％)(x2=0.935,P=0.334).Conclusions Both MVP and MVR are safe and effective in the treatment of rheumatic mitral valve disease.Compared with MVR,MVP achieves a faster postsurgical recovery,and a better left heart function protection.
NETL
NSTL
万方数据
