| Objective To explore and conclude the effects of mitral valvuloplasty (MVP) for mitral regurgitation due to myxomatous degeneration.Methods To review the clinical data and follow-up outcomes on 329 patients after MVP for mitral regurgitation due to myxomatous degeneration from Jan 1996 to Jan 2010 in the Department of Cardiothoracic Surgery of Changhai Hospital of Second Military Medical University.Results (1) There were 8 (8/329,2.4%) perioperative deaths (4 for multiple organ failure, 2 for low cardiac output,1 for malignant arrhythmia,1 for cerebral infarction). Univariate analysis shows age greater than or equal to 60 years old, course of disease more than or equal to 5 years, New York Heart Association (NYHA) functional classificationⅢ-Ⅳ, left ventricular ejection fraction (LVEF) less than 50%, bileaflet prolapse, receiving concomitant coronary artery bypass graft (CABG), cardiopulmonary bypass time were related with perioperative death. Multivariate logistic regression shows age greater than or equal to 60 years old, course of disease more than or equal to 5 years, LVEF less than 50%, receiving concomitant CABG were the independent risk factors for perioperative death.(2) There were 321 (321/329,97.6%) perioperative survivors and the ICU stay time ranged from 14 hours to 529 hours (84.2±78.5 hours) and the mechanical ventilation time ranged from 3 hours to 198 hours (17.2±21.5 hours). Postoperative transthoracic echocardiography (TTE) of all the perioperative survivors indicated that the left atrial and left ventricular dimensions were obviously decreased and mitral insufficiency was obviously improved (no regurgitation was observed in 64 patients and trace regurgitation in 96 patients and mild regurgitation in 159 patients and moderate regurgitation in 2 patients).(3) During the follow-up,32 patients were lost and 289 patients were followed up from 1 month to 150 months (46.9±32.0 months) and follow-up rate was 90.0%(289/321).287 (287/321,89.4%) patients whose follow-up were more than or equal to 12 months in perioperative survivors were chosen for survival analysis of long-term death and long-term reoperation on the mitral valve after operations.There were 10 long-term deaths after operations (6 for cardiac death,3 for noncardiac death,1 unclear). Survival at 3 years,5 years,10 years was 99.1%,97.0%,89.2%, respectively. Multivariate cox regression shows age greater than or equal to 60 years old, LVEF less than 50%, receiving concomitant CABG were the independent risk factors for long-term death after operations.There were 13 long-term reoperations on the mitral valve after operations (11 for recurrent moderate or severe mitral regurgitation,1 for endocarditis,1 for mitral stenosis). During 13 reoperations, there were 11 of mitral valve replacement,2 of re-MVP, and 3 of concomitant aortic valve replacement,5 of concomitant tricuspid valve plasty (TVP),1 of concomitant CABG and there were 2 reoperative deaths for low cardiac output. Freedom from reoperation on the mitral valve at 3 years,5 years,10 years was 98.0%,96.5%, 87.7%, respectively.(4) 196 (196/287,68.3%) patients who had long-term TTE data in 287 patients were chosen for survival analysis of long-term recurrent moderate or severe mitral regurgitation after operations (After statistical analysis, we found that loss of long-term TTE data of 91 patients had no significant effect on survival analysis of long-term recurrent moderate or severe mitral regurgitation after operations)10 patients developed recurrent severe mitral regurgitation,17 patients developed recurrent moderate mitral regurgitation, and 11 patients developed concomitant mitral stenosis. Freedom from recurrent severe mitral regurgitation at 3 years,5 years,10 years was 96.5%,93.4%,80.8%, respectively. Freedom from recurrent moderate or severe mitral regurgitation at 3 years,5 years,10 years was 88.6%,81.4%,70.4%, respectively. Multivariate cox regression shows NYHA functional classificationⅢ-Ⅳ, LVEF less than 50%, anterior leaflet prolapse were the independent risk factors for long-term recurrent moderate or severe mitral regurgitation after operations and receiving prosthetic ring or band annulopasty was a protective factor.According to NYHA functional classificationⅡ,Ⅲ-Ⅳ, LVEF less than 50% or not, anterior leaflet prolapse,posterior leaflet prolapse,bileaflet leaflet prolapse, receiving prosthetic ring or band annulopasty or not, respectively,196 patients were divided into groups for comparison of freedom from long-term recurrent moderate or severe mitral regurgitation after operations. There was significant difference on freedom from long-term recurrent moderate or severe mitral regurgitation after operations between NYHA functional classificationⅡgroup andⅢ-Ⅳgroup, and freedom from recurrent moderate or severe mitral regurgitation at 5 years was 100.0%,68.1%, respectively. There was significant difference on freedom from long-term recurrent moderate or severe mitral regurgitation after operations between LVEF less than 50% group and LVEF more than or equal to 50% group, and freedom from recurrent moderate or severe mitral regurgitation at 5 years was31.8%,93.2%, respectively. There was significant difference on freedom from long-term recurrent moderate or severe mitral regurgitation after operations between anterior leaflet prolapse group, posterior leaflet prolapse group and bileaflet prolapse group, and freedom from recurrent moderate or severe mitral regurgitation at 5 years was 69.5%, 89.5%,71.4%, respectively. There was significant difference on freedom from long-term recurrent moderate or severe mitral regurgitation after operations between receiving prosthetic ring or band annulopasty group and not receiving prosthetic ring or band annulopasty group, and freedom from recurrent moderate or severe mitral regurgitation at 5 years was 82.5%,72.9%, respectively.(5) 27 patients (27/196,13.8%) who had preoperatively mild tricuspid regurgitation in 196 patients were chosen for survival analysis of long-term moderate or severe tricuspid regurgitation after operations.2 patients developed severe tricuspid regurgitation,6 patients developed moderate tricuspid regurgitation. Freedom from moderate or severe tricuspid regurgitation at 3 years, 5 years,10 years was 66.9%,53.5%,53.5%, respectively. According to receiving concomitant TVP or not,27 patients were divided into groups for comparison of freedom from long-term moderate or severe tricuspid regurgitation after operations. There was significant difference on freedom from long-term moderate or severe tricuspid regurgitation after operations between receiving concomitant TVP group and not receiving concomitant TVP group, and freedom from moderate or severe tricuspid regurgitation at 5 years was 75.0%,38.0%, respectively.Conclusion Age greater than or equal to 60 years old, course of disease more than or equal to 5 years, LVEF less than 50%, receiving concomitant CABG were the independent risk factors for perioperative death. Age greater than or equal to 60 years old, LVEF less than 50%, receiving concomitant CABG were the independent risk factors for long-term death after operations.NYHA functional classification III-IV, LVEF less than 50%, anterior leaflet prolapse were the independent risk factors for long-term recurrent moderate or severe mitral regurgitation after operations and receiving prosthetic ring or band annulopasty was a protective factor. In addition, the patients with preoperatively mild tricuspid regurgitation, especially the patients with both preoperatively mild tricuspid regurgitation and pulmonary hypertension or tricuspid annular dilatation, should receive concomitant TVP as much as possible in order to avoid long-term moderate or severe tricuspid regurgitation after operations. |
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