Summary Of Early Results Of Mitral Repair

Objective:To summarize the clinical experience and early results of mitral repair and to optimize the treatment and effect of mitral repair.Methods:Mitral repair operations were performed in 73 patients(41males and 32 females)with mitral regurgitation from January 2016 to February 2021 in the Department of Cardiovascular surgery of the Second Hospital of Hebei Medical University,the cardiac structure and function were evaluated by three-dimensional echocardiography before,during and after operation.There were 41 male patients and 32 female patients,aged from 16to 68 years old(mean55±13.1years old),21 cases with atrial fibrillation(AF),20 cases with coronary artery disease(CAD),18 cases with hypertension,27cases with tricuspid regurgitation.Mitral regurgitation(MR)in all 73 patients were caused by different reasons,including 32 cases of rupture of chordae tendineae,14 cases of elongation chordae tendineae,18 cases of valvular thickening,59 cases of leaflet prolapse and 47 cases of valvular annulus dilatation.According to Carpentier’s classification,9 cases belong to Carpentier typeⅠ,59 cases belong to Carpentier typeⅡand 5 cases belong to CarpentierⅢb.All of them were treated with different techniques of mitral repair,including commissure stitch in 12 cases,shortening of chordae tendineae in 2 cases,extensive tissue resection in 23 cases,translocation of chordae tendineae in 6 cases,suture of chordae tendineae in 9 cases,valve leaflet fold in 9 cases,edge-to-edge suture in 15 cases,thinning of valve leaflet in 12 cases,85 artificial chordae tendineaes were implanted,and artificial rings were used in 73 cases.Results:There was no in-hospital death.The cardiac function was NYHA(New York Heart Association)grade II in 7 cases,grade III in 31 cases and grade IV in 35 cases before operation.One week after operation,The cardiac function was NYHA grade I in 45 cases,grade II in 22 cases and grade III in 6 cases.Echocardiography showed that the mitral regurgitation(MR)area decreased from(7.8±1.6)cm~2preoperation to(0.9±0.1)cm~2(P<0.01)postoperation,the left ventricular ejection fraction(LVEF)decreased from(57.5±5.8)%to(53.2±2.9)%before and after operation,and the preoperative left ventricular end-diastolic diameter(LVEDD)was(66.6±3.8)mm,and decreased to(55.6±3.8)mm(P<0.05)one week after operation.Conclusions:According to different causes of patients with mitral valve insufficiency,comprehensive and individualized surgical treatment by mitral valvuloplasty(MVP),can make good clinical early results.