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.
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.