| (Part 1)Objective:Invention Of a unique surgical technique for a preservation of Subvalvular Apparatus and posterior leaflet sparing during mitral valve replacement(MVR)in Rheumatic mitral stenotic patients.Method:Calcified core adhesion on the mitral commissure and the posterior leaflet is surgically resected with preservation of the native posterior mitral valve and its subvalvular apparatus using a unique technique.Result:Among 681 patients who underwent MVR with PML sparing and subvalvular apparatus preservation from May 2010 to May 2018,672(98.7%)patients survive and 9(1.3%)patients died.The mean aortic cross clamp time was 38.11±7.17min.Followed up period of 15.12±8.51 months,and a survival rate at 1,2,3years after MVR was 97.83%,97.27%,92.50%.(Part 2)Objective:Observe the efficacy of Chordae preservation and Posterior Mitral Leaflet Sparing during Mitral Valve Replacement in patients with Rheumatic Mitral Valve Disease.Methods:We examined the results of posterior mitral leaflet preservation during MVR in 681 patients with Rheumatic mitral valve disease.Operative and postoperative data collection included type of the surgery,cardiopulmonary bypass time,cross-clamp time,prosthesis use and the mortality rate.Left Ventricular Systolic Dimensions,left atrial diameter,left ventricular end-diastolic diameter,Left Atrial Diameter,and left ventricular ejection fraction were recorded and compared.Results;A total number of 681 patients had the operation of mitral valve replacement of which the posterior leaflet and sub-valvular apparatus preserved.All the patients were diagnosed as Rheumatic heart disease and they were surgically managed by replacing the native valve with prosthesis valve.The CPB time was 81.0±20.3min(74-215min),the aortic cross-clamp time was 38.11±7.17mm,the duration of ventilatory support was 21(20-23hrs)and the length of ICU stay was 82.1±38.2hrs.The mean follow-up was 46.5±27.0 months(range 0.1-108.3 months).A total of 9(1.33%)patients died in 90 days post-operative period due to various factors excluding worsening valvular function.Posterior mitral leaflet and subvalvular apparatus can be preserved successfully during Mitral valve replacement in patients with Rheumatic mitral valve disease.There was no subvalvular thrombosis and interferences of implanted prosthetic valves in all the reviewed and re-operated cases till with low morbidity and mortality rate.(Part 3)Background:Prosthesis-patient mismatch(PPM)may affect the clinical outcomes of patients undergoing mitral valve replacement(MVR)surgery.We aimed to investigate the incidence of PPM of the mitral position in our center and analyze the possible predictors of PPM as well as its effect on short-term outcomes.Methods;We retrospectively examined all consecutive patients with isolated or concomitant MVR at our center from 2013 to 2015.PPM was defined as an indexed effective orifice area(iEOA)of≤1.2cm2/m2.After inclusion and exclusion,a total of 681 patients were analyzed.The baseline information was collected and compared between the two groups.Multivariate logistic regression analysis was conducted to determine the preoperative predictors of PPM as well as the effect of PPM on early mortality.ResultsA total of 681patients were included in the study.PPM was detected in 15.9%of the patients while 12 patients(1.12%)met the criteria for severe PPM.Patients with PPM compared to the non-PPM patients had higher age,larger body surface area and were more likely to be male and obese.Logistic regression analysis showed that higher age,larger BSA,bioprosthesis and smaller left ventricle end-diastolic diameter were predictors of PPM.There were no significant differences between the PPM and non-PPM groups regarding post-operative complications.Logistic regression analysis showed that PPM was not a risk factor of short-term mortality(P=0.654).Also,there were no significant differences regarding short-/mid-term heart function between the PPM and non-PPM groups(P=0.902).Conclusions;Our results demonstrated that higher age,bioprosthesis,larger BSA and smaller left ventricle size were associated with mitral PPM However,PPM was not associated with poorer early outcomes after MVR surgery.In eastern of China,the prevalence of mitral valve stenosis is high;therefore,whether the standard PPM criteria are suitable for patients of this district needs to be further verified.Part 4Background:An extensive review of the concept of rheumatic heart disease:causes,physiological and pathological manifestation as well as surgical management.Previous histological outcome and animal experiments on chordea preservation and the consequences of Chordae transection.An extensive review on previous techniques of Chordae preservation.Conclusion... |
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