Cardiac surgery has a gradual change from traditional median sternotomy to minimally invasive surgery due to the appearance and application of peripheral extracorporeal circulation. There are great differences in the clinical practice of two different surgical methods in mitral valve operation. Minimally invasive thoracic surgery has the advantages of less trauma, less bleeding, faster recovery, beauty and so on. However, such surgery also has its weaknesses, such as longer learning curve, narrow operation space and high requirements of equipment. To compare the differences of early and long-term results in mitral valve operation between traditional median sternotomy and minimally invasive thoracic surgery is to better summarize and operate minimally invasive thoracic surgery for mitral valve surgery.
Heart valve replacement is the major surgical treatment of severe valvular diseases. Due to the durability and reoperation-free, mechanical valves are widely used. Bioprosthesis valves became popular recently because of long service life and no demand for lifelong anticoagulation. However, how to choose the appropriate prosthetic heart valves, especially the application of bioprosthesis valves for patients at 55 to 65 years is still a major problem. This review focuses on more effective and scientific basis for rational choice of mechanical and bioprosthesis valve.
ObjectiveTo analyze clinical experience and outcomes of bileaflet preservation in mitral valve replace-ment (MVR) for patients with severe mitral regurgitation (MR). MethodsWe retrospectively analyzed clinical data of 17 patients with severe MR who underwent MVR with bileaflet preservation in the Department of Cardiovascular surgery of Guangdong General Hospital from June 2011 to January 2013. There were 14 males and 3 females with mean age of 63.41±11.82 years (range, 38 to 82 years). There were 13 patients with atrial fibrillation. Preoperatively, 5 patients were in New York Heart Association (NYHA) functional class Ⅲ, and 12 patients were in NYHA class Ⅳ. There were 7 patients with ischemic MR, 9 patients with degenerative MR, and 1 patient with rheumatic MR. ResultsMVR with bileaflet preservation was performed for all the patients. Concomitant coronary artery bypass grafting was performed for 4 patients. Eleven patients received bioprosthetic MVR, and 6 patients received mechanical MVR. There was no in-hospital death, postoperative low cardiac output syndrome or left ventricular rupture. All the 17 patients were followed up for a mean duration of 16.44±5.02 months (range, 2 to 25 months). During follow-up, 1 patient died of severe paravalvular leak 2 months after surgery. All the other patients had good mitral valve function. None of the patients had anticoagulation or prosthetic valve related complication. Patient's heart function was significantly improved. Eleven patients were in NYHA functional class Ⅰ, 4 patients were in NYHA class Ⅱ, and 1 patient was in NYHA class Ⅲ. Cardiothoracic ratio, left atrial dimension, left ventricular end-diastolic dimension and left ventricular end-systole dimension postoperatively and during follow-up were significantly smaller than preoperative values. Postoperative left ventricular ejection fraction (LVEF) was significantly lower than preoperative LVEF(50.94%±8.78% vs. 55.31%±10.44%, P=0.04), but LVEF during follow-up was not statistically different from preoperative LVEF(55.31%±10.44% vs. 56.13%±9.67%, P=0.73), and LVEF during follow-up was significantly higher than postoperative LVEF(56.13%±9.67% vs. 50.94%±8.78%, P=0.02). There was no statistical difference between postoperative mitral pressure half-time (PHT)and PHT during follow-up (95.06±19.00 ms vs. 94.56±19.19 ms, P=0.91). ConclusionMVR with bileaflet preservation is a safe and effective surgical technique for patients with severe MR, and can significantly improve postoperative left ventricular remodeling and function.
ObjectiveTo explore the effectiveness and safety of the improved approach of intraoperative temporary epicardial pacing lead implantation in complete video-assisted cardiac surgery. Method We included 50 cardiac patients with video-assisted cardiac surgery indications in our hospital from September 2013 to November 2013. According to approach to placing intraoperative temporary epicardial pacing lead, the patients were divided into two groups including an improved group (30 patients with 17 males and 13 females at age of 45.6±15.7 years) and a traditional group (20 patients with 12 males and 8 females at age of 44.2±17.7 years). Time of temporary epicardial pacing lead implantation, potential perioperative complications, and clinical data of intraoperation and postoperation were compared between the two groups. Result All the patients survived during perioperative period. No intraoperative bleeding, no pericardial tamponade, no infection caused by pacing wires, as well as no relevant postoperative complications occurred. Implantation time in the improved group is shorter than that in the traditional group (P<0.001). No patient had been found situations like moderate pericardial effusion, as well as pacing leads shifting during the following-up period. ConclusionThe improved approach has shorten the implantation time, which is simpler and more effective. No patient suffers from postoperative complications during short-term following-up. But the effect in long-term following-up period is still contentious.
ObjectiveTo analyze risk factors and long-term outcomes of surgical treatment for isolated tricuspid regurgitation (TR) after left-sided valve replacement. MethodsWe retrospectively analyzed clinical data of 65 patients who underwent surgical treatment for severe isolated TR after left-sided valve replacement in Guangdong Cardiovascular Institute from January 2000 to June 2013. There were 12 male and 53 female patients with their age of 37-72 (52.3±8.0) years. Fifty-nine patients had atrial fibrillation (AF). There were 61 patients with functional TR and 4 patients with rheumatic TR. Six patients were in New York Heart Association (NYHA) functional class Ⅱ,40 patients were in NYHA class Ⅲ,and 19 patients were in NYHA class Ⅳ.The duration between the first and second cardiac operation was 1-26 (11.2±4.7) years. Fifty-five patients received tricuspid valve replacement (TVR) and 10 patients received tricuspid valvuloplasty (TVP). ResultsEleven patients (16.9%) died postoperatively. Univariate analysis showed that male gender,right ventricular internal dimension,preoperative serum albumin level (ALB) direct bilirubin (DBil) level,cardiopulmonary bypass (CPB) time and preoperative NYHA functional class Ⅳ were significantly correlated with postoperative death. Preoperative cardiothoracic ratio(C/T) TR area,left ventricular ejection fraction (LVEF) pulmonary arterial systolic pressure (PAs) preoperative hemoglobin(HGB) level,creatinine (Cr) level,total bilirubin (TBil) level,alanine aminotransferase (ALT) level and the duration between the first and second cardiac operation were not significantly related with surgical mortality. Multivariate logistic regression analysis showed that preoperative NYHA functional class Ⅳ was an independent risk factor of in-hospital death (OR=7.23,95% CI:1.57-33.25,P=0.01). Among the 54 survivors,50 patients (92.6%) were followed up for 1-160(47.2±43.3) months. Five patients died during follow-up including 3 TVR patients with heart failure,1 TVR patient with aortic valve obstruction and 1 TVP patient with sudden cardiac arrest. One-year and 5-year survival rates of TVR patients were 95%±3% and 89%±7% respectively,and 1-year and 5-year survival rates of TVP patients were 100% and 80%±18% respectively(P=0.92). Cox regression analysis showed that preoperative Cr level was an independent risk factor of long-term mortality (HR=1.10,95% CI:1.03-1.17,P<0.01). ConclusionIn-hospital mortality of patients with isolated TR after left-sided valve replacement who undergo surgical treatment is significantly related with preoperative overall condition and heart function. Surgical therapy should be performed before severe heart failure occurs. Postoperative 5-year survival rate is good,and long-term mortality is related with preoperative Cr level.
ObjectiveTo investigate long-term outcomes of patients without warfarin anticoagulation after isolated prosthetic aortic valve replacement (AVR) and evaluate the feasibility of short-term instead of lifelong anticoagulation therapy for low-risk AVR patients. MethodsSeven patients who underwent prosthetic AVR in Guangdong General Hospital between 1996 and 1999 but discontinued warfarin anticoagulation 3 years after surgery were regularly followed up. There were 6 male and 1 female patients with their age of 25-75 (40.0±11.4) years. These patients received warfarin anticoagulation during the first 3 years after surgery but discontinued oral anticoagulant 3 years after surgery (discontinued anticoagulation group). Fifteen patients who underwent prosthetic AVR during the same period and continued warfarin anticoagulation were enrolled as the control group (continuing anticoagulation group). International normalized ratio (INR) was set between 1.8 and 2.5 during warfarin anticoagulation period in both groups. Survival rate and the incidence of severe adverse events were compared between the 2 groups. ResultsIn the discontinued anticoagulation group,1 patient was lost during follow-up. No thromboembolic event,death or prosthetic valve thrombosis was observed. All the patients were in NYHA class Ⅰ. In the continuing anticoagulation group,3 patients were lost during follow-up. Eleven patients were in NYHA class Ⅰ and 2 patients were in NYHA class Ⅱ. Severe anticoagulation-related bleeding events occurred in 3 patients with gastrointestinal bleeding. One patient died of massive outbreak of vomiting blood,and another patient had sudden death. Ten-year survival rate was 100.0% and 86.7% in the discontinued anticoagulation group and continuing anticoagulation group, respectively. ConclusionFor low-risk patients after isolated prosthetic AVR,short-term warfarin anticoagulation may be acceptable, which means warfarin is administered only in the first 3 years after surgery and discontinued 3 years after surgery.
ObjectiveTo analyze clinical experience and outcomes of video-assisted thoracoscopic surgery (VATS)for bioprosthetic mitral valve replacement (MVR). MethodsWe retrospectively analyzed 32 patients who underwent VATS bioprosthetic MVR in the Department of Cardiovascular Surgery of Guangdong General Hospital from March to December 2013. There were 14 males and 18 females with a mean age of 55.6±17.3 years (range, 19 to 80 years), mean body weight of 55.7±9.7 kg (range, 37 to 78 kg) and mean body surface area of 1.67±0.16 m2 (range, 1.30 to 1.95 m2). Five patients had atrial fibrillation. There were 20 patients in New York Heart Association (NYHA)functional class Ⅱ, 11 patients in class Ⅲ, and 1 patient in class Ⅳ. There were 16 patients with rheumatic mitral valve disease, 11 patients with degenerative mitral valve disease, 4 patients with infective endocarditis and 1 patient with associated congenital heart disease. ResultsVATS bioprosthetic MVR was successfully performed for all the patients, including 27 patients with Medtronic Hancock Ⅱ Bioprosthesis and 5 patients with Medtronic Mosaic Bioprosthesis. Concomitantly, tricuspid valvuloplasty was performed for 13 patients and atrial septal defect repair was performed for 1 patient. There was no in-hospital death, low cardiac output syndrome or left ventricular rupture. Postoperative echocardiography showed good bioprosthetic function in all the patients without paravalvular leakage. Postoperative cardiac function significantly improved compared with preoperative cardiac function. There were 9 patients in NYHA functional class Ⅰ, 17 patients in class Ⅱ, and 6 patients in class Ⅲ. Left atrial diameter and left ventricular end-diastolic diameter examined postoperatively and 3 months after surgery were significantly smaller than preoperative values. Left ventricular ejection fraction (LVEF)examined postoperatively and 3 months after surgery was significantly lower than preoperative LVEF. ConclusionsVATS bioprosthetic MVR is a minimally invasive, safe and feasible procedure with a low postoperative morbidity. Incision size can be significantly reduced with a special type of bioprosthesis.
Objective To examine the effect and safety of thoracoscopic surgery for left atrium myxoma excision. Method Sixty-nine left atrial myxoma patients underwent excision of left atrial myxoma in our hospital between January 2012 and August 2014 year. The patients were divided into two groups according to the procedure. Thirty patients under-went thoracoscopic surgery, as a thoracoscopic group, with 8 males and 22 females, aged 47.36±13.02 years. Thirty-nine patients received median sternotomy surgery, as a median sternotomy group, with 10 males and 29 females, aged 49.17±13.09 years. The effect and safety between the two groups were compared. Results All patients survived after surgery without death and other serious complications. Compared with the median sternotomy surgery group, longer cardiopul- monary bypass and aortic cross clamp time, shorter ICU stay, ventilator support, and postoperative drainage time, shorter hospital stay time, less postoperative drainage, lower cost, and more higher rate of returning to work in 1 month after surgery were found in the thoracoscopic group with P value less than 0.05. There was no complication of stroke and other neurological complication in the two groups. All patients were followed up for 11 months to 4 years and 7 months, average age of 38.5±12.7 months. There was no recurrence in both groups. Conclusions The thoracoscopic left atrial myxoma excision cardiopulmonary is effective and safe. It can be used as a surgical treatment of left atrial myxoma preferred.