Clinical Analysis Of Mitral Valve Replacement Surgery With Functional Reconstruction Of Subvalvular Structures

Objective:To investigate the clinical results of functional reconstruction of subvalvular structures using artificial tendons during mitral valve replacement in patients with rheumatic mitral stenosis.Methods:The clinical data of patients treated with MVR for rheumatic cardiac mitral stenosis at the Second Affiliated Hospital of Nanchang University from May 2016 to May 2019 were selected for this study,and they were divided into three groups according to the intraoperative mitral subvalvular structure management,mitral valve and subvalvular tendonotomy group(MVR group),preserved posterior leaflet group(MVRP group),and subvalvular structure reconstruction using artificial tendon cord group(MVR+CT group).Preoperative data,intraoperative conditions,postoperative complications and changes in cardiac function were retrospectively analyzed among the three groups.Results:The differences in preoperative gender,age,comorbidities and cardiac function indexes were not statistically significant among the three groups(P >0.05).Intraoperative tricuspid valvuloplasty,radiofrequency ablation and atrial thrombectomy were performed in the MVR+CT group,but the differences were not statistically significant(P >0.05).The duration of extracorporeal circulation and aortic block were longer in the MVR+CT group than in the other two groups,and the differences were statistically significant(P <0.05).The difference between the three groups in postoperative complications of low cardiac output syndrome in the MVR+CT group was statistically significant(P <0.05).The differences in LAD size at 1 week and 6 months postoperatively were not significant between the three groups(P >0.05).The MVR group was larger than the MVRP and MVR+CT groups in a two-by-two comparison at 1 year postoperatively(P <0.05),and the difference between the MVRP and MVR+CT groups was not significant(P >0.05),and the difference between the three groups was significant(P<0.05)in a two-by-two comparison at 3 years postoperatively;There was no significant difference in LVEDD size at 1 week postoperatively between the three groups(P >0.05).In a two-by-two comparison at 6 months and 1year postoperatively,both the MVR and MVRP groups were larger than the MVR+CT group(P <0.05),and there was no significant difference between the MVR and MVRP groups(P >0.05).A two-by-two comparison at 3 years postoperatively,the MVR group was larger than the MVRP group(P <0.05)and the difference was not statistically significant between the MVR+CT group compared to the MVR and MVRP groups;The differences in LVESD size at 1 week and 6 months postoperatively were not significant between the three groups(P >0.05).In a two-by-two comparison at 1 year postoperatively,the MVR+CT group was smaller than the MVR and MVRP groups(P <0.05),while the difference between the MVRP and MVR groups was not statistically significant(P >0.05).LVESD at 3 years postoperatively was smaller in the MVR+CT group than in the MVR and MVRP groups(P <0.05),while the difference between the MVRP and MVR groups was not statistically significant(P >0.05);The differences in LVEF values between the three groups at 1 week,6 months and 1 year postoperatively were not significant(P >0.05).In a two-by-two comparison at 3 years postoperatively,the MVR+CT group was higher than the MVR and MVRP groups(P <0.05),while the difference between the MVRP and MVR groups was not statistically significant(P >0.05).An overall trend of postoperative decrease and then increase;The differences in LVFS values at 1 week,6 months and 1 year after surgery were not significant between the three groups(P >0.05).There was no significant difference in preoperative and postoperative review between the three groups(P<0.05).In a two-by-two comparison at 3 years postoperatively,the MVR+CT group was higher than the MVR and MVRP groups(P <0.05),while the difference between the MVRP and MVR groups was not statistically significant(P >0.05).A steady overall trend with little change;In a two-by-two comparison of PAP values at 1 week,6 months,1 year,and 3years postoperatively,the MVR group had the highest,the MVRP group the second lowest,and the MVR+CT group the lowest,with statistically significant differences between the three groups(P <0.05).There was an overall decreasing trend.Conclusion:Maintaining the integrity of the subvalvular structures of the mitral valve has the advantage of recovery of the patient’s postoperative cardiac function;Functional reconstruction of the subvalvular structures using artificial tendons is an appropriate option for mitral valve replacement that is not suitable for preservation of the subvalvular structures;Functional reconstruction of the subvalvular structures using artificial tendons in mitral valve replacement has the advantage of recovery of the patient’s cardiac function and reduction of complications.