ObjectiveTo evaluate the impact of different surgical strategies for moderate functional mitral regurgitation (FMR) at the time of aortic valve replacement (AVR) on patients' prognosis.MethodsA total of 118 AVR patients, including 84 males and 34 females, aged 58.1±12.4 years, who were complicated with moderate FMR were retrospectively recruited. Patients were divided into three groups according to the treatment strategy of mitral valve: a group A (no intervention, n=11), a group B (mitral valve repair, n=51) and a group C (mitral valve replacement, n=56). The primary endpoint was the early and mid-term survival of the patients, and the secondary endpoint was the improvement of FMR.ResultsThe median follow-up time was 29.5 months. Five patients died perioperatively, all of whom were from the group C. Early postoperative FMR improvement rates in the group A and group B were 90.9% and 94.1% (P=0.694). The mid-term mortality in the three groups were 0.0%, 5.9% and 3.9%, respectively (P=0.264), while the incidences of major cardiovascular and cerebrovascular events were 0.0%, 9.8% and 17.7%, respectively (P=0.230). Improvements of FMR in the group A and group B were 100.0% and 94.3% at the mid-term follow-up (P>0.05).ConclusionFor patients receiving AVR with moderate FMR, conservative treatment or concurrent repair of mitral valve may be more reasonable, while mitral valve replacement may increase the incidence of early and mid-term adverse events.
ObjectiveTo summarize and analyze the clinical outcomes of one-stage transcatheter aortic valve replacement (TAVR) combined with transcatheter mitral valve replacement (TMVR) in patients with concomitant severe aortic and mitral valve disease. Methods We retrospectively collected the clinical data of patients who underwent one-stage TAVR and TMVR at Beijing Anzhen Hospital between January 2019 and May 2025. Baseline characteristics, procedural details, and perioperative echocardiographic results were recorded. Survivors were followed regularly, and the incidence of major adverse cardiovascular and cerebrovascular events was assessed. ResultsA total of 12 high-risk patients with concomitant severe aortic and mitral valve disease were included, comprising 7 males with a mean age of (73.3±5.4) years. Aortic valve pathology included mixed lesions (n=1), aortic regurgitation (n=8), and aortic stenosis (n=3). Among them, 7 patients had previously undergone surgical bioprosthetic aortic valve replacement. Mitral valve pathology consisted of bioprosthetic valve degeneration leading to isolated regurgitation (n=8) or mixed lesions (n=4); 11 patients had a prior surgical bioprosthetic mitral valve replacement. All patients successfully underwent one-stage TAVR combined with TMVR, with 10 procedures performed via the transapical approach, 1 via the transfemoral approach, and 1 via a combined transfemoral-transapical approach. Valve deployment was successful in all cases, with an overall device success rate of 91.7%. The median intensive care unit stay was 1.5 (IQR 1.3, 3.4) d. Early postoperative complications included 2 perioperative deaths and 2 cases of gastrointestinal bleeding, with no other major cardiovascular events observed. During follow-up, there were no deaths, permanent pacemaker implantations, and no occurrences of moderate-to-severe valve stenosis, paravalvular leak, or left ventricular outflow tract obstruction. Conclusion This study demonstrates that one-stage TAVR combined with TMVR is safe and effective in selected high-risk patients with concomitant severe aortic and mitral valve disease, and represents a feasible therapeutic option.
This article reports a case of a 70-year-old female patient who developed bioprosthetic mitral valve deterioration 4 months after her initial valve replacement surgery, manifesting as severe regurgitation and New York Heart Association Class Ⅲ. Due to the high risk of a redo open-heart surgery, she underwent a transapical transcatheter mitral valve-in-valve procedure. Intraoperatively, a J-Valve prosthesis was successfully implanted under echocardiographic and fluoroscopic guidance. Immediate transesophageal echocardiography confirmed an optimal valve position, complete resolution of regurgitation, and no significant paravalvular leak or left ventricular outflow tract obstruction. The patient's postoperative course was uneventful. She was extubated 16 hours post-procedure with significant improvement in cardiac function. Follow-up echocardiography showed normal prosthetic valve function.
Mitral regurgitation is the most common cardiac valve disease, with high rates of morbidity and mortality. Transcatheter mitral valve replacement (TMVR) is used as a promising intervention in non-surgical patients and in those with unsuitable anatomy for transcatheter edge-to-edge repair. TMVR can also be performed for inoperable or high-risk patients with degenerated or failed bioporstheses or failed repairs, or in patients with severe annular calcifications. The complex anatomy of the mitral valves makes the design of transcatheter mitral valve prostheses extremely challenging, and increases the difficulty of TMVR procedure, thus could led to non-negligible complications including periprocedural and post-procedural long-term complications. This review aims to discuss the potential TMVR-complications and measures implemented to mitigate these complications, in order to improve the prognosis of TMVR patients.
Objective To investigate the safety and efficacy of mitral valve replacement combined with cryoablation Maze surgery in patients with atrial functional mitral regurgitation (AFMR). Methods From January 2014 to June 2020, patients with AFMR who underwent mitral valve replacement in our department were enrolled. They were divided into two groups, a cryoablation Maze group who received cryoablation Maze surgery during mitral valve replacement, and a non-cryoablation Maze group who did not receive cryoablation Maze surgery. The baseline data, surgical data, efficacy, and prognosis between the two groups were compared. Results Finally 85 patients were enrolled. There were 16 males and 24 females with an average age of 58.65±6.86 years in the cryoablation Maze group, and 24 males and 21 females with an average age of 61.29±8.30 years in the non-cryoablation Maze group. There was no statistical difference in baseline data between the two groups (P＞0.05). The aortic occlusion time and extracorporeal circulation time of the cryoablation Maze group were longer than those of the non-cryoablation Maze group with statistical differences (P＜0.01). There was no statistical difference in postoperative ICU retention time, ventilator assistance time, length of hospital stay, intraoperative blood loss, drainage volume on the first day or occurrence rate of complications (temporary pacemaker application, electrical cardioversion, thoracic puncture drainage, hospitalization death) between the two groups (P＞0.05). At the time of discharge, postoperative 3-month, 6-month, 12-month, and 24-month, the maintenance rates of sinus rhythm in the non-cryoablation Maze group were statistically different from those of the cryoablation Maze group (P＜0.001). Compared with the non-cryoablation Maze group, the decrease values of left atrial diameter, left ventricular end-diastolic diameter, left ventricular end-systolic diameter and pulmonary artery systolic pressure were statistically different (P＜0.05). Postoperative cardiac function grading of both groups was grade Ⅰ or Ⅱ, which was significantly improved compared with preoperative level, but there was no statistical significance between the two groups (P＞0.05). There was no statistical difference in the incidence of adverse events during follow-up (P＞0.05). ConclusionCryoablation Maze surgery combined with mitral valve replacement is safe and effective in the treatment of AFMR patients, which is conducive to the recovery and maintenance of sinus rhythm, and is beneficial to the remodeling of the left atrium and left ventricle, the reduction of pulmonary systolic blood pressure, and the improvement of life quality of the patients.
ObjectiveTo compare the clinical outcomes of mitral valvuloplasty (MVP) and mitral valve replacement (MVR) for infective endocarditis, and to investigate the effect of MVP under different surgical risks. MethodsA retrospective study was done on the patients with mitral infective endocarditis, who underwent surgical treatment in our department from January 2018 to March 2022. According to the procedures, the patients were divided into a MVP group and a MVR group. Propensity score matching method was applied with a ratio of 1:1 to eliminate the biases. The early and midterm outcomes were compared between the two groups after matching. According to the European System for Cardiac Operative Risk Evaluation Ⅱ(EuroSCORE-Ⅱ), the effect of MVP was compared between high and low risk patients. ResultsA total of 195 patients were collected. There were 141 patients in the MVP group (120 males, 85.1%) and 54 patients in the MVR group (41 males, 75.9%). The mean follow-up time was (34.0±16.1) months. Patients in the MVP group were younger [(42.7±14.6) years vs. (56.8±13.0) years, P<0.001] and had better preoperative conditions. The patients in the MVP group had a shorter ICU stay [3.0 (2.0, 5.0) d vs. 4.0 (3.0, 8.0) d, P=0.004], and lower incidences of low cardiac output syndrome (0.7% vs. 9.3%, P=0.007), in-hospital mortality (0.0% vs. 3.7%, P=0.023), and follow-up mortality (4.3% vs. 15.4%, P=0.007). However, after 1:1 propensity score matching, there were no statistical differences in the baseline data or postoperative and follow-up adverse events between the two groups (P>0.05). Also, there was no statistical difference in the mortality of high-risk patients between MVP and MVR group (P>0.05). There was no statistical difference in the reoperation or recurrent severe mitral regurgitation between high and low-risk patients in the MVP group (P>0.05). Conclusion MVP is feasible for treating mitral lesions caused by infective endocarditis with good early and midterm outcomes. For patients with severer preoperative conditions, if the leaflet damage is not severe, MVP may be a viable option, but validation with larger sample sizes is needed.
Thoracoscopic mitral valve replacement is a common minimally invasive cardiac surgery procedure. However, small annulus, severe calcification of the annulus, and severe thickening of the posterior valve leaflet or sub valvular structure are the difficulties of thoracoscopic mitral valve replacement. Improper treatment can easily lead to left ventricular rupture or prosthesis-patient mismatch. This paper reports a thoracoscopic mitral bioprosthesis replacement case using the chimney technique in Guangdong Provincial People's Hospital and summarizes its operating key points. The patient was a 68-year-old female, weighing 36 kg. The preoperative diagnosis was rheumatic mitral stenosis and atrial fibrillation, the preoperative transthoracic echocardiogram showed the left ventricular end-diastolic diameter was 39 mm. The surgical effect was satisfactory. The patient was in good condition at the follow-up 2 months after the operation.
ObjectiveTo investigate the feasibility, safety and effectiveness of radiofrequency ablation of atrial fibrillation with mitral valve replacement under totally thoracoscopic surgery.MethodsThe clinical data of 107 patients with rheumatic mitral disease and atrial fibrillation who underwent mitral valve replacement and radiofrequency ablation at the same time in our hospital from January 2014 to October 2018 were retrospectively analyzed. The patients were divided into two groups: a totally thoracoscopic surgery group (n=51, including 20 males and 31 females, aged 50.57±5.24 years) and a median sternotomy group (n=56, including 21 males and 35 females, aged 52.12±5.59 years) according to the surgical methods. The preoperative, intraoperative and postoperative data of the patients were compared.ResultsAll operations were successfully completed without death. In terms of bleeding volume, drainage volume, ventilator-assisted breathing time, hospital stay and incision length, the totally thoracoscopic surgery group was better than the median sternotomy group, and the difference was statistically significant (P<0.05). The cardiopulmonary bypass time and radiofrequency ablation time in the totally thoracoscopic surgery group were longer than those in the median sternotomy group (P<0.05). There was no significant difference in the operation time, aortic occlusion time, postoperative complications, left ventricular ejection fraction, left atrial diameter and sinus rhythm maintenance between the two groups (P>0.05). There was no atrioventricular block, pulmonary vein stenosis, atrioesophageal fistula, coronary artery injury, stroke or hemorrhage during the follow-up.ConclusionRadiofrequency ablation of atrial fibrillation with mitral valve replacement under totally thoracoscopic surgery is safe and effective, and it is worthy of clinical application.
Objective To compare the mid- and long-term clinical results of mitral valve plasty (MVP) and mitral valve replacement (MVR) 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 MVP were divided into a MVP group, and those who underwent MVR into a MVR group. The clinical data and mid-term follow-up efficacy of two groups were compared. Results Finally 236 patients were included. There were 100 patients in the MVP group, including 53 males and 47 females, with an average age of (61.80±8.03) years. There were 136 patients in the MVR group, including 72 males and 64 females, with an average age of (61.29±8.97) years. There was no statistical difference in baseline data between the two groups (P＞0.05). There was no statistical difference between the two groups in the extracorporeal circulation time, aortic occlusion time, postoperative hospital and ICU stay, 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 (P=0.022). 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 statistical differences in the left atrial diameter, left ventricular end-diastolic diameter, left ventricular end-systolic diameter and cardiac function between the two groups compared with those before surgery (P<0.05). The postoperative left ventricular ejection fraction in the MVP group was statistically higher than that before surgery (P=0.002), but there was no statistical difference in the MVR group before and after surgery (P=0.658). The left atrial diameter in the MVP group was reduced compared with the MVR group (P=0.026). The recurrence rate of mitral regurgitation in the MVP group was higher than that in the MVR group, and the difference was statistically significant (10.0% vs. 1.5%, P=0.003). There were 14 deaths in the MVP group and 19 in the MVR group. The cumulative survival rate (P=0.605) and cardiovascular events-free survival rate (P=0.875) were not statistically significant between the two groups by Kaplan-Meier survival analysis. Conclusion The safety, and mid- and long-term clinical efficacy of MVP in the treatment of FMR patients are better than MVR, and the left atrial and left ventricular diameters 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 mitral regurgitation recurrence.
Mitral regurgitation (MR) is one of the most common valvular heart diseases, imposing a significant economic burden on society. Transcatheter mitral valve replacement (TMVR), as an emerging therapeutic strategy for MR, is expected to fill the gap in the treatment of transcatheter edge-to-edge repair in the future. This article reviews the progress of TMVR clinical research both domestically and internationally in the past two years and analyzes the current challenges faced by TMVR research, such as mitral valve anatomy, device access transition, valve design, and mitral valve calcification. Finally, the prospects of mitral valve product research are discussed.
