Objective To investigate the effect of edgetoedge mitral valve plasty on left ventricular diastolic function and in order to find the validity and safety of this procedure. Methods From Feb. 2006 to Dec. 2007, thirty cases with mitral regurgitation were divided into two groups. Quadrangular resection was performed on fifteen cases with posterior proplapse in control group, and edgetoedge mitral valve plasty was performed on fifteen cases with anterior or bileaflet proplapse in experimental group, and ring annuloplasty(Medtronic ring) was used in both groups. The hemodynamics were monitored and recorded with SwanGanz catheter at the time of postoperation，2 h, 4 h, 6 h and 12 h after operation. Left ventricular diastolic function was also evaluated with echocardiography using color Doppler and tissue Doppler imaging in the patients with sinus rhythm. The ratio of the peak E velocity and A velocity(E/A), the ratio of the early diastolic peak flow velocity to the early diastolic mitral valve annular movement velocity(E/Em), and the ratio of early diastolic mitral valve annular movement velocity to late diastolic mitral valve annular movement velocity（Em/Am）were measured before operation and 1 week after operation respectively. Results Mitralvalve area were significantly reduced at 1 week after operation compared with that before operation in both groups (control group 3.63±1.06 cm2 vs. 7.18±2.41 cm2, experimental group 3.44±1.02 cm2 vs. 6.51±3.06 cm2, Plt;0.05）; and mitral regurgitant grade were significantly reduced at 1 week after operation in both groups as well(control group 0.53±0.64 cm2 vs.3.60±0.51 cm2, experimental group 0.67±0.82 cm2 vs.3.40±0.63 cm2, Plt;0.05). However, there was no significant difference for mitral valve area and mitral regurgitant grade between two groups before and after operation（Pgt;0.05）. In experimental group, there were no significant change of evaluations of E/A,E/Em and Em/Am before and after operation（E/A 1.28±0.36 vs. 1.95±1.06,E/Em 8.79±2.16 vs. 8.13±3.02, Em/Am 1.39±0.38 vs. 1.31±041，Pgt;0.05). There was no significant change of pulmonary artery wedge pressure (PAWP) before and after operation between two groups（13.60±4.37 mm Hg vs.12.20±3.53 mm Hg, Pgt;0.05）. Conclusion Edgetoedge mitral valve plasty technique is available and has no significant influence on left ventricular diastolic function, and a doubleorifice mitral valve has similar hemodynamic change compared with a physiological mitral valve.
Thoracoscopic minimally invasive technology has been used in mitral valve plasty since 1990s. Totally thoracoscopic mitral valve plasty has the advantages of small trauma, beautiful incision and rapid postoperative recovery. It is favored by more and more patients and cardiac surgeons. However, according to the reports, the proportion of totally thoracoscopic mitral valve surgery in China is still low. Mitral valve plasty via the totally thoracoscopic approach is still controversial in terms of population adaptation, perioperative complications and long-term prognosis. In addition, the technical difficulty and the long training cycle of surgeons also limit the popularization of this technology. By summarizing the existing literature, this paper analyzes the application and development of totally thoracoscopic approach in comparison with the traditional median thoracotomy mitral valve plasty.
Objective To compare the mid- and long-term clinical results of mitral valve plasty and mitral valve replacement in the treatment of functional mitral regurgitation (FMR). MethodsPatients with FMR who underwent surgical treatment in the Department of Cardiovascular Surgery of the General Hospital of Northern Theater Command from 2012 to 2021 were collected. The patients who underwent mitral valve arthroplasty were divided into a MVP group, and those who underwent mitral valve replacement into a MVR group. The preoperative clinical data, operative and perioperative data of the two groups were analyzed retrospectively, and the mid- and long-term follow-up results were compared. Results Finally 236 patients were included. There were 100 patients in the MVP group and 136 patients in the MVR group. The total follow-up rate was 100.0%, the longest follow-up was 10 years, and the average follow-up time was 3.60±2.55 years. There were 14 cumulative deaths in the MVP group and 19 in the MVR group. There was no statistical difference in baseline data between the two groups (P＞0.05). There was no statistical difference between the MVP group and the MVR group in the incidence of adverse events such as extracorporeal circulation time, aortic occlusion time, hospital stay time in the ICU, intraoperative blood loss, or hospitalization death (P＞0.05), but the time of mechanical ventilation in the MVP group was significantly shorter than that in the MVR group, and the difference was statistically significant(P=0.022).There were statistical differences in the left atrial diameter, left ventricular end-diastolic inner diameter, left ventricular end-systolic inner diameter and cardiac function grade between the two groups compared with those before surgery (P<0.05). The left ventricular ejection fraction in the postoperative MVP group was statistically higher than that before surgery (P<0.05), but there was no statistical difference in the postoperative MVR group compared with that before surgery (P>0.05). The LAD in the MVP group was reduced compared with the MVR group, and the difference was statistically different (P<0.05). The recurrence mitral regurgitation in MVP group was higher than that in MVR group, and the difference was statistically significant（10% vs.1.5%, P=0.003）. The cumulative survival rate (P=0.605) and mortality from cardiovascular events (P =0.880) were not statistically significant in the two groups by Kalan-Meier survival analysis. Conclusion The safety and medium- and long-term clinical efficacy of MVP in the treatment of FMR patients were better than MVR, and the left atrium and left ventricle diameter are statistically reduced, and cardiac function is statistically improved. However, the surgeon needs to be well aware of the indications for the MVP procedure to reduce the rate of MR recurrence.