ObjectiveTo analyze clinical experience and outcomes of bileaflet preservation in mitral valve replace-ment (MVR) for patients with severe mitral regurgitation (MR). MethodsWe retrospectively analyzed clinical data of 17 patients with severe MR who underwent MVR with bileaflet preservation in the Department of Cardiovascular surgery of Guangdong General Hospital from June 2011 to January 2013. There were 14 males and 3 females with mean age of 63.41±11.82 years (range, 38 to 82 years). There were 13 patients with atrial fibrillation. Preoperatively, 5 patients were in New York Heart Association (NYHA) functional class Ⅲ, and 12 patients were in NYHA class Ⅳ. There were 7 patients with ischemic MR, 9 patients with degenerative MR, and 1 patient with rheumatic MR. ResultsMVR with bileaflet preservation was performed for all the patients. Concomitant coronary artery bypass grafting was performed for 4 patients. Eleven patients received bioprosthetic MVR, and 6 patients received mechanical MVR. There was no in-hospital death, postoperative low cardiac output syndrome or left ventricular rupture. All the 17 patients were followed up for a mean duration of 16.44±5.02 months (range, 2 to 25 months). During follow-up, 1 patient died of severe paravalvular leak 2 months after surgery. All the other patients had good mitral valve function. None of the patients had anticoagulation or prosthetic valve related complication. Patient's heart function was significantly improved. Eleven patients were in NYHA functional class Ⅰ, 4 patients were in NYHA class Ⅱ, and 1 patient was in NYHA class Ⅲ. Cardiothoracic ratio, left atrial dimension, left ventricular end-diastolic dimension and left ventricular end-systole dimension postoperatively and during follow-up were significantly smaller than preoperative values. Postoperative left ventricular ejection fraction (LVEF) was significantly lower than preoperative LVEF(50.94%±8.78% vs. 55.31%±10.44%, P=0.04), but LVEF during follow-up was not statistically different from preoperative LVEF(55.31%±10.44% vs. 56.13%±9.67%, P=0.73), and LVEF during follow-up was significantly higher than postoperative LVEF(56.13%±9.67% vs. 50.94%±8.78%, P=0.02). There was no statistical difference between postoperative mitral pressure half-time (PHT)and PHT during follow-up (95.06±19.00 ms vs. 94.56±19.19 ms, P=0.91). ConclusionMVR with bileaflet preservation is a safe and effective surgical technique for patients with severe MR, and can significantly improve postoperative left ventricular remodeling and function.
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 examine the effect and safety of thoracoscopic surgery for left atrium myxoma excision. Method Sixty-nine left atrial myxoma patients underwent excision of left atrial myxoma in our hospital between January 2012 and August 2014 year. The patients were divided into two groups according to the procedure. Thirty patients under-went thoracoscopic surgery, as a thoracoscopic group, with 8 males and 22 females, aged 47.36±13.02 years. Thirty-nine patients received median sternotomy surgery, as a median sternotomy group, with 10 males and 29 females, aged 49.17±13.09 years. The effect and safety between the two groups were compared. Results All patients survived after surgery without death and other serious complications. Compared with the median sternotomy surgery group, longer cardiopul- monary bypass and aortic cross clamp time, shorter ICU stay, ventilator support, and postoperative drainage time, shorter hospital stay time, less postoperative drainage, lower cost, and more higher rate of returning to work in 1 month after surgery were found in the thoracoscopic group with P value less than 0.05. There was no complication of stroke and other neurological complication in the two groups. All patients were followed up for 11 months to 4 years and 7 months, average age of 38.5±12.7 months. There was no recurrence in both groups. Conclusions The thoracoscopic left atrial myxoma excision cardiopulmonary is effective and safe. It can be used as a surgical treatment of left atrial myxoma preferred.