Objective To evaluate postoperative quality of life （QOL） of patients aged over 65 after mitral valvereplacement （MVR）. Methods Ninety patients aged over 65 undergoing MVR by the same surgical group in Departmentof Cardiovascular Surgery of Anzhen Hospital were prospectively enrolled in this study. There were 62 male and 28 femalepatients with their age of 65-76 （68.6±6.8） years. There were 55 patients with hypertension，38 patients with type 2 diabetes，and all the patients had persistent atrial fibrillation. Nottingham Healthy Profile （NHP，Part I） and Duke Activity StatuIndex （DASI） were used to evaluate preoperative and postoperative QOL. According to the choice of prosthetic heart valves they received，all the patients were divided into two groups with 45 patients in each group: biological valve group and mechanical valve group. All the patients received MVR via the interatrial groove approach under general anesthesia and cardiopulmonary bypass. Mechanical valve replacement was performed using continuous suture without preserving the posterior leaflet of the mitral valve. Biological valve replacement was performed using interrupted suture and some of the posteriorleaflet of the mitral valve was routinely preserved. Patients in both groups underwent intraoperative bilateral pulmonary vein isolation and left atrial appendage ablation using a bipolar radiofrequency ablation device. The left atrial appendage was not excised or ligated. Results Postoperative QOL of all the patients was significantly better than preoperative QOL. There was no statistical difference in NHP and DASI at the 6th month after discharge between the 2 groups. But from the 1st year after discharge，QOL of the biological valve group was significantly better than that of the mechanical valve group. At the 3rd year after discharge，NHP and DASI of the mechanical valve group was not statistically different from those at the 1st year after discharge，but NHP and DASI of the biological valve group was significantly better than those at the 1st year after discharge. Conclusions QOL of elderly patients are significantly improved after MVR. Patients who receive biologicalvalve replacement may acquire better long-term QOL than patients who receive mechanical valve replacement.
Abstract: Objective To compare the change of left heart funct ion in pat ients w ith bio logical valves replacement of small ao rt ic roo t w ith mechanical valve rep lacement, and to find w hether there is p ro sthesis-patient mismatch (PPM ) or not after operation. Methods Left ventricular ejection fraction (LV EF ) , left ventricular fractional shortening (LVFS) , left vent ricular mass index, the indexed effective orifice area (EOA I) , and peak pressure gradients across aortic valve in 20 patients with small aortic root (≤21mm in diameter) receiving biological valves rep lacement (biological valves group ) were studied by Doppler echocardiography before the operation and 6 months to 1 year after operation. The results were compared with those of 20 patients who received mechanical valves replacement (mechanical valves group ). Results Comparing with those before operation, there was a significant increase in LVEF, LV FS, EOAI of all patients 6 months to 1 year after operation . There was a significant reduction in the left ventricular mass index, peak pressure gradients across aortic valve in all patients. EOAI of all patients were between 0.88 cm2/m2 and 1. 32 cm 2/m 2. LVEF, LVFS, EOAI, left ventricular mass index, and peak pressure gradients across aortic valve between biological valves group and mechanical valves group (79% ±8% vs. 81%±10%; 43%±9% vs. 37%±8%; 1. 11±0. 14 vs. 0. 92±0. 11; 89. 10±16. 70g/m 2 vs. 95. 30±15.10 g/m 2; 18. 80±12. 60 mmHg vs. 22. 30±12. 00 mmHg) showed no significant difference 6 months to 1 year after operation (P gt;0.05). Conclus ion Patients with small aortic root receiving biological valves have a significant increase in the left heart function, and have no PPM.
Objective To evaluate the early and middlelongterm clinical results of tricuspid valve replacement (TVR) and compare the relative merit between bioprothesis and mechanical valve in tricuspid position，so as to elevate the operative effect. Methods The data of 128 TVR from April 1992 to February 2008 in An Zhen Hospital were retrospectively reviewed， and classified into mechanical prosthesis group（n=89）and bioprothesis group（n=39）according to the prosthesis used in the first procedure. Kaplan-Meier curve were estimated to evaluate the midlong term survival rate and events incidence related to prosthesis（including thrombosis, embolism and bleeding related to prosthesis and the prosthesis deterioration）. Multivariate binary logistic regressions were used to evaluate the independent risk factor for early and late death. Results There were 19 early deaths( 14.84%). With the followup of 4.93±2.92 years, there were 11 late deaths(10.7%). According to the Kaplan-Meier curve, the 10year actuarial survival rate for the bioprothesis group and mechanical prosthesis group were 65.6%±17.4% and 68.7%±10.8% respectively(Log-rank test,χ2=0.74，P=0.390). Freedom from prosthesis-related embolism at 5 years for the bioprothesis group and mechanical prosthesis group were 92.3%±7.4% and 87.1%±4.6% respectively(Log-rank test, χ2=0.962，P=0.327). Freedom from anticoagulationrelated bleeding at 10 years for the bioprothesis group and mechanical prosthesis group were 100% and 79.7%±9.7% respectively(Log-rank test, χ2=1.483，P= 0.223). There were 9 TVR reoperation, freedom from reoperation at 7 years for the bioprothesis group was 71.1%±18.0%, and freedom from reoperation at 10 years for the mechanical prosthesis group was 78.8%±10.2% (Log-rank test, χ2=2.76，P=0.096). Binary logistic regression revealed that the redo procedure and ascites were independent risk factors for early death, whereas ascites, heart function of New York Heart Association class Ⅲ/Ⅳ and multi valve replacement were independent risk factors for late death.Conclusion To lower the operative mortality and late mortality and morbidity, TVR should be adopted prior to the deterioration of right heart function, and bioprothesis valve has similar early and middlelong term clinical effect with mechanical valve in tricuspid position.
Objective To investigate the biological and biomechanical characteristics of acellular porcine aortic valve with dye mediated photo oxidation so that a new and better bioprosthetic valve materials can be obtained. Methods Thirty porcine aortic valves were divided into three groups with random number table. Acellular valves (n=10) were stabilized by dye mediated photo oxidation in dye mediated photo oxidation group; acellular valves (n=10) were stabilized by glutaraldehyde in glutaraldehyde group; and acellular valves (n=10) were acellularized only in acellular valves group. Thickness, appearance, histology, water content, shrinkage temperature, breaking strength and soluble protein level of acellular porcine aortic in three groups were tested respectively. Results There were light blue, soft, flexible and unshrinking valves in dye mediated photo oxidation group. Compared to valves in glutaraldehyde group, valves in dye mediated photo oxidation group had lighter thickness（0.26±0.09mm vs. 0.38±0.08mm，Plt;0.05）, more water content（86.30%±4.03% vs. 71.10%±3.23%，Plt;0.05）, and lower shrinkage temperature （76.30±0.70℃ vs. 87.70±0.30℃，Plt;0.05）; while these indexes had no statistically significant differences compared to those in acellular valves group. At the same time, compared to valves in acellular valves group, valves in dye mediated photo oxidation group had more breaking strength（17.33±2.65 mPa vs. 9.11±0.95 mPa，Plt;0.05） and lower soluble protein level（0.039%±0.013% vs. 0.107%±0.024%，Plt;0.05）; while these indexes had no statistically significant differences compared to those in glutaraldehyde group. Conclusion Acellular porcine aortic valve stabilized by dye mediated photo oxidation has nice biological and biomechanical characteristics.
Objective To analyze the medium-and long-term r esults of tricuspid valve replacement(TVR), to summarize the experience in opera tive therapy for tricuspid valve disease. Methods From January 1998 to May 2006, sixty seven patients had undergone TVR. The etiology was rheumatic disease in 25 cases, congenital disease in 37 cases, degenerative disease in 1 case, infective endocarditis in 3 cases, a nd cardiac tumor in 1 case. All operations were performed under general anesthes i a and by cardiopulmonary bypass. Bioprostheses was replaced in 28 patients, whil e mechanical valve was replaced in 39 patients. Associated procedure included mi tral valve replacement in 13 cases, mitral valve replacement and aortic valve replac ement in 12 cases, repair of ventricular septal defect in 1 case, repair of atri al septal defect in 1 case, and radioablation of atrial fibrillation in 3 case s. Results The operative mortality was 11.94% (8/67)，among these patients , 6 cases died of serious heart failure,1 case died of ventricular fibrillation, 1 case died of multi organ failure. During follow-up, 1 patient died of biopro thesis dysfunction 1 year after the operation, 1 patient died of cerebral emboli s m 6 years after the operation. Through statistical analysis, it showed that the mortality of TVR in rheumatic tricuspid valve disease was higher than that in co ngenital tricuspid valve disease ［5.56%（2/36）vs. 24.00% (6/25); χ2=4.425 , P=0.036］; the mortality in second time operation was higher than that in first time operation ［30.00%（3/10）vs. 8.77% (5/57);χ2=3.646，P=0.033 ］; while there was no significant difference in immediate and long-term result s with different choice of bioprosthetic or mechanical valve in TVR (χ2=0.002 , P=0.961). Conclusion Operative an d follow-up mortality is high in the TVR, valve replac ement is the last selection for the treatment of serious tricuspid disease, appr opriate operative technique and perioperative therapy is the key for success o f the operation.