ObjectiveTo explore surgical techniques and follow-up results of concomitant transaortic repair for moderate functional mitral regurgitation (MR)during surgical treatment for aortic root or aortic valve disease. MethodsClinical data of 25 patients who underwent concomitant transaortic repair for moderate functional MR during surgical treat-ment for aortic root or aortic valve disease between January 2006 and June 2012 in Xinhua Hospital were retrospectively analyzed. There were 18 male and 7 female patients with their age of 42-75 (57.9±9.6)years. All these patients had aortic root or aortic valve disease as well as concomitant moderate functional MR (type I Carpentier's classification). Aortic valve replacement or aortic root replacement and concomitant transaortic mitral valvuloplasty (MVP, commissure repair)were performed under general anesthesia, hypothermia and cardiopulmonary bypass. Patients were followed up at the outpatient department as well as with phone calls to evaluate the structures and function of the mitral valve and the heart. ResultsIntraoperative transesophageal echocardiography showed satisfactory MVP results as trivial residual MR in 2 patients and no MR or mitral stenosis in the other 23 patients. There was no in-hospital death in this group. Postoperative echocardiography showed that left atrial diameter and left ventricular end-diastolic dimension were significantly reduced than preoperative values (t=4.086, P=0.000;t=4.442, P=0.000), and left ventricular ejection fraction (LVEF)was significantly lower than preoperative LVEF (t=3.671, P=0.001). Postoperative mitral annulus diameter (MAD)was smaller than preoperative MAD (32.4±3.6 mm vs. 35.6±6.4 mm). Postoperative mitral valve pressure gradient (MVPG)(1.4±0.7 mm Hg vs. 1.5±0.7 mm Hg)and peak MVPG (3.7±2.2 mm Hg vs. 3.3±1.5 mm Hg)were no statistical difference than preoperative values. Twenty-three patients (92%)were followed up after discharge for 7-92 (50.4±25.3)months, and the other 2 patients were lost in follow-up. Three patients had mild MR during follow-up. Latest echocardiography examination showed MAD was 33.9±4.6 mm, MVPG was 1.3±0.6 mm Hg, and peak MVPG was 3.6±2.3 mm Hg. ConclusionConcomitant transaortic MVP during surgical treatment for aortic root or aortic valve disease is a safe, convenient and effective procedure for the treatment of moderate functional MR.
ObjectiveTo compare the safety and clinical outcomes of isolated aortic valve replacement (AVR)through right anterior minithoracotomy (RAMT)and conventional median sternotomy. MethodsFrom March 2006 to March 2013, 169 patients underwent isolated AVR in Department of Cardiothoracic Surgery, Xinhua Hospital, Shanghai Jiaotong University School of Medicine. Among them, 42 patients received AVR via RAMT (RAMT group)including 30 males and 12 females with their age of 59.31±8.30 years. And 127 patients received AVR via conventional median sternotomy (conventional surgery group)including 89 males and 38 females with their age of 60.02±5.93 years. There were 75 patients with aortic valve stenosis (AS), 42 patients with aortic regurgitation (AR)and 52 patients with AS+AR. Postoperative outcomes were compared between the 2 groups. ResultsThere was no statistical difference in preoperative clinical characteristics between the 2 groups. All the patients successfully received isolated AVR. 153 patients received mechanical prosthesis and 16 patients received bioprosthetic valves. Fifty-two patients received 21 mm valves, and 117 patients received 23 mm valves. Cardiopulmonary bypass time and aortic cross-clamping time of RAMT group were significantly longer than those of conventional surgery group (P < 0.001). But mechanical ventilation time, length of postoperative ICU stay and hospital stay of RAMT group were significantly shorter than those of conventional surgery group (P < 0.001). Postoperative thoracic drainage, intraoperative and postoperative blood transfusion of RAMT group were significantly less than those of conventional surgery group (P < 0.001). In conventional surgery group, 2 patients underwent reexploration for bleeding and 2 patients had wound infection postoperatively. Two patients died postoperatively, both in conventional surgery group, including 1 patient with low cardiac output syndrome and multiple organ dysfunction syndrome, and another patient with prosthetic valve endocarditis secondary to sternal wound infection. ConclusionCompared with conventional median sternotomy, RAMT is safe and efficacious for patients undergoing isolated AVR with minimal surgical injury, better postoperative recovery and cosmetic outcomes.