Abstract： Objective To explore the optimal timing and treatment of acquired Lutembacher’s syndrome. Methods Sixteen acquired Lutembacher’s syndrome patients were studied retrospectively based on records collected between January 2000 and December 2009 in Beijing Anzhen Hospital. There were 9 males and 7 females at age of （39.45±10.23）years. All of them underwent endotracheal intubation, intravenous general anesthesia, and cardiopulmonary bypass. All patients were operated on through a median sternotomy incision into the chest, the right atrium, atrial septal defect to expand with mitral valve replacement and atrial septal defect repair. Postoperative mortality and perioperative complications were observed. During follow-up, periprosthetic leakage was observed using echocardiography, along with the level of residual atrial septal shunt, ventricular size, pulmonary artery pressure changes, and improvement in cardiac function. Results Two of the 16 patients（12.5%）died, one of renal failure, and one of respiratory failure. One patient required extracorporeal membrane oxygenation for 3 days, one required continuous renal replacement therapy for 11 days because of acute renal failure, and one experienced respiratory failure and used a respiratory machine for 23 days. All three of those patients recovered. Fourteen patients were followed up for between six months and five years, and the follow-up rate was 100%. The left ventricular end-diastolic diameter was （42.1±5.7） mm, as measured by echocardiography six months post-operation. There was no detectable periprosthetic leakage or residual shunt. The ejection fraction was （67.4%±6.7%）, and estimation of pulmonary artery pressure was （23.4±5.4） mm Hg. Twelve patients were class Ⅱ（ New York Heart Association） and two patients were class Ⅲ. Conclusion Acquired Lutembacher’s syndrome should be treated promptly if patients’ left ventricular end stage diastolic volume index is good enough to ensure they can tolerate surgery. Extracorporeal membrane oxygenation （ECMO）should be used early in patients who are anticipated to be difficult to withdraw from extracorporeal circulation perioperatively.
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 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.