Early And Mid-Term Follow-Up Study Of MVR And MAVR In Rheumatic Heart Disease With Mild Aortic Disease

Objective:In clinical practice,it’s still controversial whether mild aortic valve disease should be treated at the same time in patients with rheumatic combined valve disease undergoing mitral valve replacement(MVR).However,there don’t have enough reports which cover large sample size about the benefits of rheumatic heart disease patients with aortic valve mild and mild-moderate disease,in which patients have undergone mitral valve replacement and aortic valve management simultaneously.In this study,we take effect a follow up study in a single center that focus on the patients with rheumatic heart disease(RHD)who underwent MVR and also has mild aortic valve disease in the same time.We evaluated the surgical risk and early to moderate term outcomes of MVR versus mitral and aortic combined valve replacement,and preliminarily explore the optimal treatment for this patient group.Methods:This study retrospectively analyzed the information of patients who underwent MVR surgery in the Qilu Hospital of Shandong University from January 1,2015 to December 31,2019 because of RHD.This study analyzed the UCG information before surgery according to the current diagnostic criteria of echocardiography.Aortic valve disease were classified into four levels:none,mild,moderate and severe.Patients with non mild aortic valve disease and receiving biological valve replacement were excluded.Finally,patients who underwent MVR combined with mild aortic valve disease were included in the cohort study.According to the different treatment of aortic valve,we set up two groups and named them group A and B,that the patients in group A underwent MVR,and group B were the patients who underwent mitral and aortic combined valve replacement.A preliminary statistical screening of all quantified variables in the database was performed for inter group statistical processing,including baseline information,intraoperative and perioperative date,UCG information,and early to moderate term follow up information.Statistical methods mainly include:Pearson chi square test or Fisher exact probability method was used to analyze the count date between groups;independent sample t test was used for measurement date;Log Rank and COX regression analysis were used to screen the independent risk factors for the postoperative endpoint events.Results:According to the selection criteria,there are a total of 104 patients in this retrospective study,and group A have 70 patients(67.3%),group B have 34 patients(32.7%).Baseline information was similar between the two group(P>0.05).Preoperative UCG showed that there was no different in the degree of mitral valve disease(P=0.567),type of mitral valve disease(P=0.269),the degree aortic valve disease(all of them were mild lesions in group A and B),type of aortic valve disease(P=0.093)and LVEF(P=0.729)between groups A and B.Intraoperative and perioperative date:the average operation time(P<0.001),average cardiopulmonary bypass time(P<0.001),average aortic time(P<0.001),average auxiliary time(P=0.028)and intraoperative plasma consumption(P=0.048)in group B were more than those in group A.Postoperative date:UCG showed that there was no different in the degree of mitral valve lesion(P=0.353)and postoperative LVEF(P=0.623)between groups A and B.There don’t have obvious early complications related to prosthetic valve replacement were found in all patients.Early and mid-term follow up:the median follow up time was 50 months,2 patients died in the 30 days after operation,4 patients died after leave hospital,and 1 patient accept another operation due to the progress of heart disease.The early postoperative mortality in group B was higher than that in group A(P=0.040),which was statistically significant.The cause of death were statistically analyzed,and there was no significant different between the two groups in the incidence of end point events(P=0.153),the incidence of cardiac death(P=0.484),the overall survival rate(P=0.068).Multivariate COX regression analysis base on statistical date showed that age(P=0.025),LVEF before operation(P=0.042)and operation time(P=0.038)were independent risk factors.The early and mid-term follow up of aortic valve disease degree in group A showed that the rate of no aortic valve disease progress compared with that before discharge(P=0.958).Conclusion:Firstly,MVR alone can reduce the operation related time,intraoperative plasma consumption and early mortality in patients with rheumatic combined valvular disease.Second,the mild-term aortic valve re-intervention rate,the incidence of cardiac death and overall survival rate were not different form those of combined valve replacement.In conclusion,the patients who have rheumatic combined valvular disease with mild aortic valve disease should be taken conservative strategy.Prophylactic aortic valve replacement will not bring better early and medium term results.