ObjectiveTo summarize mid- to long-term results of edge to edge mitral repair for mitral regurgitation (MR). MethodsClinical data of 31 patients who underwent edge to edge mitral repair in Nanjing Drum Tower Hospital from June 2002 to June 2008 were retrospectively reviewed. There were 13 male and 18 female patients with their age of 14-77 (43±21) years. Clinical and echocardiographic data were analyzed. ResultsThree patients died in hospital,and 28 patients finished mid- to long-term follow-up for 5-10 years. During follow-up, 1 patient died of acute decompensated heart failure in the 2nd year after discharge. Two patients had recurrent moderate MR, and 6 patients had recurrent moderate-to-severe MR including 3 patients who underwent mitral valve replacement in the 5th,6th and 7th postoperative year respectively because of severe MR. Five-year reoperation-free rate was 88.9% (24/27). Five-year mortality was 3.6% (1/28). The incidence of recurrent moderate or severe MR within 5 postoperative years was 28.6% (8/28). ConclusionFor complex MR or as an emergency substitute strategy for failed routine mitral valvuloplasty, edgeto- edge mitral repair can produce good mid- to long-term outcomes except for Carpentier Ⅲb MR.
Objective To analysis correlation factors for preoperative sudden death of patients with type A aortic dissection in order to determine clinical management strategy.?Methods?We retrospectively analyzed clinical data of 52 patients with type A aortic dissection who were admitted in Department of Cardiothoracic Surgery of the Affiliated Drum Tower Hospital of Nanjing University Medical School from January 2003 to January 2010. According to the presence of preoperative death, all the patients were divided into two groups, 9 patients in the preoperative sudden death （PSD）group including 7 males and 2 females with their mean age of 52.0±12.1 years；43 patients in the control group including 31 males and 12 females with their mean age of 51.5±10.9 years. Univariate and multivariate logistic regression analysis were used for analysis of preoperative factors related to sudden death.?Results?Univariate analysis result showed 7 candidate variables：body mass index （BMI, Wald χ2=2.150, P=0.143）, time of onset （Wald χ2=2.711, P= 0.100）, total cholesterol （TC, Wald χ2=1.444, P=0.230）, low density lipoprotein cholesterol （L-C, Wald χ2=1.341, P=0.247）, aortic insufficiency （AI, Wald χ2=2.093, P=0.148）, aortic sinus involvement （Wald χ2=3.386, P=0.066）and false lumen thrombosis （Wald χ2=7.743, P=0.005）. Multivariate logistic regression analysis showed that BMI （Wald χ2=4.215, P=0.040, OR=1.558）and aortic sinus involvement （Wald χ2=4.592, P=0.032, OR=171.166 ）were preoperative risk factors for sudden death, and thrombosed false lumen （Wald χ2=5.097, P=0.024, OR=0.011）was preoperative protective factor for sudden death.?Conclusion?Type A aortic dissection patients with large BMI and/or aortic sinus involvement should receive operation more urgently than others and patients with thrombosed false lumen may have relatively low risk of preoperative sudden death.
ObjectiveTo evaluate the clinical efficacy of tricuspid valve re-operation after left cardiac valve surgery. MethodsWe retrospectively analyzed the clinical data of 23 patients underwent tricuspid valve re-operation in the Affiliated Drum Tower Hospital of Medical School, Nanjing University from January 2009 to November 2014. There were 3 males and 20 females with a mean age 53.48±10.79 years ranging from 34 to 71 years. The average body mass index of the 23 patients was 21.77±2.42 kg/m2. We followed up all the patients in outpatient department or through telephone for 3 months to 5 years. ResultsAll surgeries were operated under cardiopulmonary bypass. There were 15 patients underwent operation through medisternal incision and 8 patients underwent operation through the fourth intercostal incision of right anterolateral side. The mean operation time was 284.35±56.16 minutes and the mean time of cardiopulmonary bypass was 138.61±46.91 minutes. One patient died postoperatively and 2 patients chose to discharge automatically after operation. The other 20 patients recovered and discharged uneventfully. We followed up the patients for 3 months to 5 years. One patient underwent permanent pacemaker therapy for atrioventricular block, 3 patients accepted pharmaceutical therapy for atrial arrhyttmia, 1 patient underwent re-operation for infectious endocarditis of left cardiac artificial valve. and the follow-up conditions of the rest patients were well. Besides, the follow-up data showed that there was a mild regurgitation in 3 patients underwent tricuspid valve plasty. ConclusionTricuspid valve re-operation after left cardiac valve surgery can take multiple surgical pathways and strategies. The clinical effect has been proved and the midterm follow-up condition is well, but we still need the long-term follow-up for the further effect.
ObjectiveTo evaluate the in-hospital and long-term outcomes of patients receiving mitral valve replacement with mechanical or biological prosthesis.MethodsThe clinical data of patients undergoing mitral valve replacement in our center between January 2005 and August 2018 were retrospectively analyzed. Patients with emergency, reoperation, bleeding or embolic events or incomplete clinical data were ruled out.ResultsTotally 569 patients were enrolled, including 325 with mechanical prosthesis (a mechanical prosthesis group, 111 males and 214 females with a mean age of 55.54±4.09 years) and 244 bioprosthesis (a bioprosthesis group, 90 males and 154 females with a mean age of 60.02±4.28 years). There was no significant difference in the in-hospital mortality between the two groups (P=0.250). The survival rate at postoperative 15 years of the bioprosthesis group was higher than that of mechanical prosthesis group (78.69% vs. 66.25%, χ2=8.844, P=0.003). No remarkable differences were found in prosthesis failure (P=0.183) and thromboembolism events (P=0.505) between the two groups. Bleeding occurred more frequently in the mechanical prosthesis group (P=0.040). After the propensity-score matched analysis based on the age, the survival rate was still higher in the bioprosthesis group than in the mechanical prosthesis group (P=0.032).ConclusionBiological prosthesis can be considered as the preferable choice in mitral valve replacement procedure in order to improve the long-term survival and decrease the frequent of bleeding events.