Objective
To summarize safety and effectiveness of cryomaze ablation procedure concomitant with valve surgery.
Methods
We retrospectively investigated the clinical data of 62 patients (24 males and 38 females) with mean age of 49.4±14.2 years who underwent cryomaze ablation procedure concomitant with valve surgery in our hospital from August 2013 through July 2015. The heart rhythm of the patients after surgery was supervised by 12-leads electrical cardiogram respectively.
Results
The rate of sinus rhythm restored right after surgery was 98.4%. The rate of sinus rhythm restored at the time of discharge was 93.4%. The rate of sinus rhythm restored 3 months, 6 months, 12 months, 18 months after surgery was 90.2%, 87.3%, 85.0%, 83.3% respectively. The one-year post-operation rate of sinus rhythm restored for the group of right minimal invasive thoracoscopic assisted mitral valve surgery was 90.5%. Longer duration for atrial fibrillation (>7 years) was a risk factor for the reoccurrence of atrial fibrillation 1 year after surgery (P<0.05).
Conclusion
Cryomaze ablation procedure concomitant with valve surgery is quite effective in treatment of rheumatic valve disease and atrial fibrillation. This approach is associated with fewer complications, comparable atrial fibrillation reoccurrence for short-term follow-up.
Objective
To investigate the myocardial protective effects of Del Nido cardioplegia and analyze its advantages in adult cardiac surgery.
Methods
We retrospectively analyzed the clinical data of 96 adult patients undergoing cardiac valve surgery who received Del Nido cardioplegia (a DNC group) from June 2016 to January 2017 in our hospital. There were 44 males and 52 females with a mean age of 51.36±13.31 years. Meanwhile 96 patients who received conventional cardioplegia were recruited as a control group (a CTC group) and there were 53 males and 43 females with a mean age of 52.91±10.95 years. Cross-clamping time, cardiopulmonary bypass (CPB) time, total volume of and transfusion frequency of cardioplegia, the rate of spontaneous defibrillation, red blood cell transfusion and vasoactive-inotropic score at postoperative 24 hours (VIS 24) were recorded.
Results
No significant difference was found in age, body weight, ejection fraction, hematokrit, CPB time and cross-clamping time between the DNC group and CTC group. There was no significant difference in the rate of spontaneous defibrillation, VIS 24, cardiac enzymes and cardiactroponin I and length of ICU stay between the two groups. The total volume and transfusion frequency of cardioplegia, perioperative blood transfusion were lower in the DNC group. There was no new atrial fibrillation or in-hospital death in the two groups.
Conclusion
Del Nido is a good myocardial protection solution in adult cardiac valve surgery, and requires less static preload volume and reduceshemodilution and perioperative blood transfusion.
Objective To compare the effect of palliative mitral valve surgeries and medication therapies for secondary non-ischemic mitral regurgitation. Methods The clinical data of patients with non-ischemic functional mitral regurgitation treated in our hospital between 2009 and 2019 were retrospectively analyzed. Patients with a left ventricular ejection fraction (LVEF)＜40% underwent a dobutamine stress test, and a positive result was determined when the LVEF improved by more than 15% compared to the baseline value. Positive patients were divided into a surgery group and a medication group. The surgery group underwent surgical mitral valve repair or replacement, while the medication group received simple medication treatment. Follow-up on survival and cardiac function status through outpatient or telephone visits every six months after surgery, and patients underwent cardiac ultrasound examination one year after surgery. The main research endpoint was a composite endpoint of all-cause death, heart failure readmission, and heart transplantation, and the differences in cardiac function and cardiac ultrasound parameters between the two groups were compared. ResultsUltimately 41 patients were collected, including 28 males and 13 females with an average age of 55.5±11.1 years. Twenty-five patients were in the surgery group and sixteen patients in the medication group. The median follow-up time was 16 months, ranging 1-96 months. The occurrence of all-cause death in the surgery group was lower than that in the medication group (HR=0.124, 95%CI 0.024-0.641, P=0.034). The difference between the two groups was not statistically significant in the composite endpoint (HR=0.499, 95%CI 0.523-1.631, P=0.229). The New York Heart Association (NYHA) grade of the surgery group was better (NYHA Ⅰ-Ⅱ accounted for 68.0% in the surgury group and 18.8% in the medication group, P<0.01) as well as the grade of mitral valve regurgitation (87.5% of the patients in the medication group had moderate or above regurgitation at follow-up, while all the patients in the surgery group had moderate below regurgitation, P<0.01). There was no statistical difference in preoperative and follow-up changes in echocardiograph parameters between the two groups (P＞0.05). Conclusion For non-ischemic functional mitral regurgitation, if the cardiac systolic function is well reserved, mitral valve surgery can improve survival and quality of life compare to simple medication therapy.
ObjectiveTo compare early outcomes of the minimally invasive mitral valve surgery (MIMVS) through right anterolateral mini-thoracotomy (ALMT) with conventional mitral valve surgery (MVS), and evaluate feasibility and safety of MIMVS.
MethodsFrom January 2011 to December 2013, 120 patients undergoing elective MVS in Nanjing First Hospital were prospectively enrolled in this study. There were 72 male and 48 female patients with their age of 22-71 (42.4±11.0) years. Using a random number table, all the patients were randomly divided into a portaccess MIMVS group (MIMVS group, n=60) and a conventional MVS group (conventional group, n=60). MIMVS group patients received port-access cardiopulmonary bypass (CPB) establishment via femoral artery, femoral vein and right internal jugular vein cannulation through right ALMT 5-6 cm in length. Special MIMVS operative instruments were used for mitral valve repair or replacement. Conventional group patients received mitral valve repair or replacement under conventional CPB through median sternotomy. Perioperative clinical data, morbidity and mortality were compared between the 2 groups.
ResultsThere was no death in-hospital or shortly after discharge in this study. CPB time (98.0±26.0 minutes vs. 63.0±21.0 minutes) and aortic cross-clamping time (68.0±9.0 minutes vs.37.0±6.0 minutes) of MIMVS group were significantly longer than those of conventional group (P<0.05). Postoperative mechanical ventilation time (6.0±3.9 hours vs. 11.2±5.6 hours), length of ICU stay (18.5±3.0 hours vs. 28.6±9.5 hours) and postoperative hospital stay (8.0±2.0 days vs. 13.5±2.5 days) of MIMVS group were significantly shorter than those of conventional group (P<0.05). Chest drainage volume within postoperative 12 hours (110.0±30.0 ml vs. 385.0±95.0 ml) and the percentage of patients receiving blood transfusion (25.0% vs. 58.3%) of MIMVS group were significantly lower than those of conventional group (P<0.05). Patients were followed up for 1-24 months, and the follow-up rate was 94.2%. There was no statistical difference in postoperative morbidity or mortality between the 2 groups (P>0.05).
ConclusionMIMVS through right ALMT is a safe and feasible procedure for surgical treatment of mitral valve diseases. MIMVS can achieve similar clinical outcomes as conventional MVS, but can significantly shorten postoperative ICU stay and hospital stay, reduce blood transfusion, and is a good alternative to conventional MVS.
Objective To retrospectively review the clinical experience and early surgical results of combined cardiac valve surgery and coronary artery bypass grafting （CABG）. Methods From Jan. 2000 to Dec. 2005, combined valve surgery and CABG was performed in 81 patients. 37 patients were rheumatic heart disease with coronary stenosis, and 44 patients were coronary artery disease with valvular dysfunction. Single vessel disease was in 18 patients, two vessels disease in 9 and triple-vessel disease in 54. All the patients received sternotomy and combined valve surgery and CABG under cardiopulmonary bypass. Mitral valve repair and CABG were done in 26 patients. Valve replacement and CABG were done in 55 patients with 49 mechanical valves and 16 tissue valves. Four patients had left ventricular aneurysm resection concomitantly. The number of distal anastomosis was 3.12 5= 1.51 with 66 left internal mammary arteries bypassed to left anterior descending. Post-operative intra-aortic balloon pump was required in 4 cases for low cardiac output syndrome. Results Two patients died of low cardiac output syndrome with multiple organs failure. 79 patients had smooth recovery and discharged from hospital with improved heart function. 64 patients had completed follow-up with 5 late non cardiac related death in a mean follow-up period of 14.2 months. Conclusion Combined one stage valve surgery and CABG is effective with acceptable morbidity and mortality.
ObjectiveTo analyze factors affecting the recovery of postoperative left ventricular function in patients with valvular disease combined with heart failure with reduced ejection fraction [HFrEF, left ventricular ejection fraction (LVEF)<40%].MethodsThe clinical data of 98 patients with valvular disease combined with HFrEF who underwent surgeries in our hospital from January 2011 to June 2018 were retrospectively analyzed, including 75 males and 23 females aged 9-78 (55.3±11.9) years.ResultsA total of 15 patients were dead after the operation, including 4 deaths within 3 months and 11 mid-long-term deaths after the operation. Ninety-one patients were followed up for more than 6 months (10 months to 8.6 years). The postoperative cardiac function (NYHA) of 91 patients was classⅠ-Ⅱ, the LVEF of 18 (19.8%) patients increased more than 10%, that of 47 (51.6%) patients maintained at the preoperative level, and that of 26 (28.6%) patients decreased. Postoperative LVEF was more prone to recover in HFrEF patients with sinus rhythm before operation (P=0.038), valvular disease mainly in aortic valve (P=0.026), obvious reduction of left ventricular end diastolic diameter in early postoperative period (P=0.017), and higher systolic pulmonary artery pressure (SPAP) before operation (P=0.018). The risk factors for postoperative LVEF deterioration included large left atrium before operation (P=0.014), smaller left ventricle end systolic diameter before operation (P=0.003), and fast heart rate after operation (P=0.019). ConclusionMitral valve prolapse patients with obviously increased left ventricular diameter should receive operation as soon as possible. HFrEF patients with aortic valve disease should receive operation positively. The operation efficacy is satisfactory in the HFrEF patients with high SPAP.
ObjectiveTo compare the outcomes of concomitant mitral valve surgery and tricuspid valve surgery through right minithoracotomy and conventional median sternotomy approaches.
MethodsWe retrospectively analyzed clinical data of 475 patients underwent mitral valve surgery combined with tricuspid valve surgery through right minithoracotomy or conventional median sternotomy in Xinhua Hospital between June 2006 and June 2013. The patients were divided into two groups including a minimally invasive group(116 patients) and a conventional group (359 patients).
ResultsAll the patients successfully underwent mitral valve and tricuspid valve surgery. During operation, there were 426 patients with no trivial mitral regurgitation (MR) and 49 patients with trivial MR. There were 282 patients with no tricuspid regurgitation (TR) and 193 patients with trivil TR. At discharge, transesophageal echocardiography showed that trivial MR in 38 patients, mild MR in 5 patients, trivial tricuspid regurgitation (TR) in 150 patients and mild TR in 7 patients. There was no significant difference between the two groups in complications.
ConclusionRight minithoracotomy can achieve the similar therapeutic effect to conventional median sternotomy for patients with mitral valve disease and concomitant tricuspid valve disease. In addition, patients through right minithoracotomy had better cosmetic outcomes.
Objective To analyze and explore the risk factors of secondary tricuspid regurgitation (TR) after left-sided valve surgery (left cardiac valve replacement or valvuloplasty) using meta-analysis, so as to provide evidence for clinical diagnosis and treatment of secondary TR. Methods We electronically searched databases including PubMed, MEDLINE, CBM, CNKI, VIP, for literature on the risk factors of secondary TR after left-sided valve surgery from 1995 to 2012. According to the inclusion and exclusion criteria, we screened literature, extracted data, and assessed methodological quality. Then, meta-analysis was performed using RevMan 5.0 software. Results A total of 6 case-control studies were included, involving 437 patients and 2 102 controls. The results of meta-analysis showed that, the risk factors of progressive exacerbation of secondary TR after left-sided valve surgery included preoperative atrial fibrillation (OR=3.90, 95%CI 3.00 to 5.07; adjusted OR=3.04, 95%CI 2.21 to 4.16), age (MD=5.36, 95%CI 3.49 to 7.23), huge left atrium (OR=5.17, 95%CI 3.12 to 8.57; adjusted OR=1.91, 95%CI 1.49 to 2.44) or left atrium diameter (MD=4.85, 95%CI 3.18 to 6.53), degradation of left heart function (OR=2.97, 95%CI 1.73 to 5.08), rheumatic pathological change (OR=3.06, 95%CI 1.66 to 4.68), preoperative TR no less than 2+ (OR=3.52, 95%CI 1.26 to 9.89), and mitral valve replacement (MVR) (OR=2.35, 95%CI 1.68 to 3.30). Sex (OR=1.54, 95%CI 0.94 to 2.52) and preoperative pulmonary arterial hypertension (OR=1.28, 95%CI 0.77 to 2.12) were not associated with secondary TR after left-sided valve surgery. Conclusion The risk factors of progressive exacerbation of secondary TR after left-sided valve surgery include preoperative atrial fibrillation, age, huge left atrium or left atrium diameter, degradation of left heart function, rheumatic pathological change, preoperative TR no less than 2+, and MVR. Understanding these risk factors helps us to improve the long-time effectiveness of preventing and treating TR after left-sided valve surgery.
ObjectiveTo assess the accuracy of European System for Cardiac Operative Risk Evaluation (EuroSCORE) model in predicting the in-hospital mortality of Uyghur patients and Han nationality patients undergoing heart valve surgery.
MethodsClinical data of 361 consecutive patients who underwent heart valve surgery at our center from September 2012 to December 2013 were collected, including 209 Uyghur patients and 152 Han nationality patients. According to the score for additive and logistic EuroSCORE models, the patients were divided into 3 subgroups including a low risk subgroup, a moderate risk subgroup, and a high risk subgroup. The actual and predicted mortality of each risk subgroup were studied and compared. Calibration of the EuroSCORE model was assessed by the test of goodness of fit, discrimination was tested by calculating the area under the receiver operating characteristic (ROC) curve.
ResultsThe actual mortality was 8.03% for overall patients, 6.70% for Uyghur patients,and 9.87% for Han nationality patients. The predicted mortality by additive EuroSCORE and logistic EuroSCORE for Uyghur patients were 4.03% and 3.37%,for Han nationality patients were 4.43% and 3.77%, significantly lower than actual mortality (P<0.01). The area under the ROC curve of additive EuroSCORE and logistic EuroSCORE for overall patients were 0.606 and 0.598, for Han nationality patients were 0.574 and 0.553,and for Uyghur patients were 0.609 and 0.610.
ConclusionThe additive and logistic EuroSCORE are unable to predict the in-hospital mortality accurately for Uyghur and Han nationality patients undergoing heart valve surgery. Clinical use of these model should be considered cautiously.
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.
