ObjectiveTo compare short- and medium-term effects of Leonardo da Vinci robot-assisted and traditional mitral valvuloplasty.MethodsWe conducted a retrospective analysis of 74 patients who underwent mitral valvuloplasty in our hospital from January 2015 to March 2017. The patients were divided into two groups according to the mode of operation: a da Vinci group (n=29, 13 males, 16 females at an average age of 52 years) and a routine group (n=45, 18 males, 27 females at an average age of 53 years). The perioperative data of patients in the two groups were compared and analyzed.ResultsThere was no significant difference in sex, age, weight, height, body mass index (BMI), cardiac function (NYHA), hypertension, diabetes, postoperative blood transfusion and postoperative complications between the two groups (P>0.05). The tracheal intubation time, ICU retention time, hospital stay time, blood loss and postoperative drainage in the da Vinci group were shorter or less than those in the routine group (P<0.05). The operation time, cardiopulmonary bypass time and aortic clamping time in the da Vinci group were longer than those in the routine group (P<0.05). Different surgical procedures had no significant effect on left atrial diameter (LAD), left ventricular end-diastolic diameter (LVEDD), left ventricular ejection fraction (LVEF) and mitral regurgitation (MR) 3 years after operation. There was no interaction between the mode of operation and the time of follow-up. There was no significant difference in echocardiographic evaluation in the same period (P>0.05).ConclusionDa Vinci operation shortens the rehabilitation process of patients compared with traditional surgery. For short- and medium-term follow-up results, there is no difference between Leonardo da Vinci and traditional mitral valve surgeries, and the clinical effect of da Vinci robot-assisted mitral valvuloplasty is satisfactory, which is worthy of further clinical promotion.
Minimally invasive cardiac surgeries are the trend in the future. Among them, robotic cardiac surgery is the latest iteration with several key-hole incision, 3-dimentional visualization, and articulated instrumentation of 7 degree of ergonomic freedom for those complex procedures in the heart. In particular, robotic mitral valve surgery, as well as coronary artery bypass grafting, has evolved over the last decade and become the preferred method at certain specialized centers worldwide because of excellent results. Other cardiac procedures are in various stages of evolution. Stepwise innovation of robotic technology will continue to make robotic operations simpler, more efficient, and less invasive, which will encourage more surgeons to take up this technology and extend the benefits of robotic surgery to a larger patient population.
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.
Abstract: Objective To observe the longterm condition of patients after mitral valve replacement with or without mild aortic valve regurgitation (AR) and discuss whether treatment of AR is necessary during the course of mitral valve replacement. Methods From March 1999 to April 2004, 88 patients who underwent mitral valve replacement (with or without mild AR before surgery) in West China Hospital of Sichuan University were followed up for 5 years or more. The patients were divided into two groups according to whether they had mild AR based on the result of preoperative echocardiography examination. In the AR group, there were 35 patients including 7 males and 28 females aged 49.26±11.87. By the New York Heart Association (NYHA) grading system before surgery, 4 patients were classified as Class Ⅱ, 26 Class Ⅲ and 5 Class Ⅳ. In the nonAR group, there were 53 patients including 7 males and 46 females aged 48.59±10.22. Using the NYHA grading system before surgery, we found there were 7 patients with Class Ⅱ cardiac function, 39 Class Ⅲ and 7 Class Ⅳ. After operation, all patients were followed up regularly and 5 years after surgery, patients were examined by echocardiography again. Results The followup period ranged from 5 to 9 years (6.39±1.26). There was no statistical difference in gender (P=0.394), age (P=0.841), preoperative cardiac function (P=0.960) and cardiac rhythm (P=0.732) between the two groups. For the AR group, after operation, NYHA heart function, left ventricle ejection fraction (LVEF) and left ventricle fraction shortening (LVFS) significantly increased or improved(Plt;0.05). In the nonAR group, after operation, NYHA heart function and LVEF significantly improved (Plt;0.05), while LVFS had no significant change (Pgt;0.05). Left [CM(159mm]ventricular dimensions (LVD) and aortic dimensions between the two groups had no significant difference afteroperation (Pgt;0.05). There was no significant difference in the number of AR cases before and after surgery (Pgt;005) in the AR group, while there was a significant difference in the nonAR group (Plt;0.05). Conclusion For patients with mild AR who underwent mitral valve surgery 5 to 9 years ago, there is little change in their AR condition. There is no need to treat mild AR preventively during the course of mitral valve replacement.
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 summarize the experiences of surgical treatment for post infarction ventricular aneurysm and mi tral regurgitation， thus to improve surgical curative effect and survival rates . Clinical data of 37 patients with myocardial infarction complicated with ven tricular aneurysm and severer than moderate mitral regurgitation were retrospectively an alyzed between December 2000 and June 2007, all 37 patients underwent coron ary artery bypass grafting and reconstruction of left ventricular after aneurysm resection, mitral valve repair or replacement. Results Three patients died during hospital stay after surgery,mortality rate was 81%, of th em two died in renal failure, one died in brain complications.Thirty patients we re followed up, followup rate was 88.2%(30/34), with 4 patients missed. Follow up time ranged from 1 month to 6 years after surgery, 2 patients died in foll o wup period, of them one died in anticoagulant treatment failure complicated w ith the large cerebral infarction, one died of lung infection and heart failure. The inner diameter of le ft atrium and enddiastolic left ventricle reduced obviously than those before operation （30.1±3.5mm vs.39.3±3.7mm, P=0.004;48.4±4.3mm vs.61.2±5.1mm, P=0.003）by color doppler echocardiography examination at 6th month a fter su rgery.There was no obvious change in size of untouched ventricular aneurysm(diam eterlt;5cm). No regurgitation or slight regurgitation were observed in 12 patient s, mild regurgitation was observed in 2 patients and moderate in 1 patients. Conclusion According to different types of post infarctio n ventricular aneurysm and mitral regurgitation, constitution o f different surgical treatment programs, can result in favorable early and long-term curative effect. There’s marked improvement in most patients’cardiac f unction and survival rate.
Objective
To compare long-term outcomes following mitral valvuloplasty (MVP) and mitral valve replacement (MVR) for native valve endocarditis (NVE).
Methods
Between November 1993 and August 2016, consecutive 101 patients with NVE underwent mitral surgery in our department, MVP for 52 patients and MVR for 49 patients. There were 69 males and 32 females at age of 38.1±14.9 years. The mean follow-up was 99.4±75.8 months.
Results
There was no statistical difference in cardiopulmonary bypass time, aortic cross-clamp time, in-hospital mortality, duration of mechanical ventilation, ICU stay or hospital stay after surgery between the two groups. Survival rate at 1, 5, 10, 20 years after surgery was 100.0%, 97.6%, 97.6%, 97.6% for MVP, and 93.5%, 84.3%, 84.3%, 66.2% for MVR with a statistical difference between the two groups (P=0.018). There was no stroke in the patients with MVP during follow-up periods. However, stroke-free survival rate at 1, 5, 10, 20 years after surgery was 100.0%, 93.9%, 89.4%, 70.2% for MVR patients with a statistical difference between the two groups (P=0.023). There was no statistical difference in recurrence of infection, perivalvular leakage and reoperation between the two groups. Composite endpoint-free survival rate at 1, 5, 10, 20 years after surgery was 100.0%, 97.6%, 92.9%, 92.9% for MVP, and 91.3%, 79.6%, 75.8%, 51.0% for MVR with a statistical difference (P=0.006).
Conclusion
MVP is associated with better outcomes than MVR in the patients with NVE; generalizing MVP technique in the patients with NVE is needed.
Mitral regurgitation (MR) is the most common heart valve disease. In recent years, the rise of interventional therapy has expanded the indications of interventional treatment for patients with MR, but the epidemiological characteristics of MR (especially the number of patients with MR requiring treatment) in China are still unclear. In this paper, we analyzed and estimated the number of MR patients in China based on three epidemiological studies in Europe and America, and referring to the patients population surveys from Zhongshan Hospital Affiliated to Fudan University, the Second Affiliated Hospital Zhejiang University School of Medicine and Beijing Fuwai Hospital. Our analysis estimated that about 7.5 million patients with MR need intervention in China, including about 5.5 million patients with severe MR.
