Comparative Study On The Clinical Efficacy Of Mitral Valve Plasty And Replacement In The Treatment Of Moderate And Severe Ischemic Mitral Valve Insufficiency

Objective: to compare the early efficacy and adverse events of mitral valvuloplasty and mitral valve replacement in the treatment of moderate to severe ischemic mitral regurgitation,so as to provide theoretical basis for the treatment of scientific,reasonable and individualized ischemic mitral regurgitation.Methods: the cases of moderate and severe ischemic mitral regurgitation hospitalized in the fourth affiliated Hospital of New Medical University from January 1,2010 to June 30,2018 were analyzed retrospectively.under the premise of strict control of risk factors,different surgical methods were performed.It will be divided into forming group and replacement group.To compare the early effects of mitral valvuloplasty and mitral valve replacement on the prognosis of moderate to severe ischemic mitral regurgitation(cardiothoracic ratio,left ventricular diastolic diameter,left ventricular systolic diameter,ejection fraction and adverse events).The purpose of this study is to provide a theoretical basis for the formulation of scientific,reasonable and personalized treatment of ischemic mitral regurgitation.Results: Before operation,the cardiothoracic ratio in the shaping group and the replacement group was 0.63±0.06.the results ofmm,t test showed that the t value was 0.71 and the P value was 0.48.before operation,the cardiothoracic ratio in the shaping group and the replacement group was 0.64±0.05,0.63±0.06 in the replacement group.The left ventricular end diastolic value in the shaping group was(60.32±6.33)mm,replacement group was(58.60±5.29)mm;t test results showed that the t value was 1.40,P value was 0.16.The left ventricular end diastolic value in the shaping group was(60.32±6.33)mm;t test group(58.60±5.29).The end systolic end of left ventricle in the angioplasty group was(47.84±7.31)mm,replacement group was(50.90±6.11)mm;t test results showed that t value was 2.28,P value was 0.024.The(EF)of left ventricular ejection fraction(LVEF)in the shaping group was(41.48±9.79)%,and that in the replacement group was(44.91±10.57)%.The results of t test showed that t value was 2.45,P value was 0.016.Before and after operation in the replacement group,the cardiothoracic ratio was(0.63±0.06),(0.58±0.07)t test results showed that t=3.84 P=0.0002;The end diastolic diameter of left ventricle was(58.60±5.29)mm,(55.47±7.21)mm,t test results showed that t=2.48,P=0.015;The end systolic diameter of left ventricle was(50.90±6.11)mm,(48.25±7.98)t=1.89P=0.06.the left ventricular ejection fraction(LVEF)was(44.91±10.57)%,(40.60±9.83)mm,t test results showed that t=2.12 P=0.036;Before and after operation,the cardiothoracic ratio was(0.64±0.05),(0.55±0.05)t test showed t=2,P=0.048;The end diastolic diameter of left ventricle was(60.32±6.33)mm.The results ofmm,t test showed that t value was 3.833,P value was 0.0003.The end diastolic diameter of left ventricle was 60.32±6.33±5.72±5.72±5.72±5.72±5.72).Left ventricular end systolic diameter(47.84±7.31)mm,(44.28±7.01)t test showed that t=2.486 P=0.015;left ventricular ejection.The blood fraction was(41.48±9.79)%,(44.8±9.05)%,t=1.77 P=0.084,t=1.77 P=0.084;After operation,the cardiothoracic ratio in the shaping group and the replacement group was(0.58±0.07)mm,t=2.54 and P=0.012,respectively.The left ventricular end diastolic meridian in the angioplasty group was(55.72±5.72)mm,replacement group(55.47±7.21)mm;t=0.192,P=0.85.The end systolic end of left ventricle in the angioplasty group was(44.28±7.01)mm,replacement group(48.25±7.98)mm;t=2.64,P=0.009.The left ventricular ejection fraction(EF)in the shaping group was(44.8±9.05)%,and that in the replacement group was(40.60±9.83)%.The t test showed that the left ventricular ejection fraction(LVEF)was(44.8±9.05)% and(40.60±9.83)%,respectively(t=2.22,P=0.028).Before and after operation in the replacement group,the average cardiopulmonary bypass was(70±20)minutes,the average blocking time was(40±12)minutes,the average cardiopulmonary bypass was(69±23)minutes,and the average blocking time was(37±13)minutes in the replacement group.The P values were 0.75 and 0.10,respectively.Conclusion: in the replacement group,the cardiothoracic ratio and end-diastolic diameter were improved before and after operation,the end-systolic diameter of left ventricle had no significant change,and the ejection fraction decreased.The cardiothoracic ratio,end-diastolic diameter and end-systolic diameter decreased in the shaping group.There was no significant change in ejection fraction.The cardiothoracic ratio and left ventricular end diastolic diameter were significantly improved in the two groups.There was no significant difference that the average blocking time,cardiopulmonary bypass time and the incidence of adverse events during hospitalization in the shaping group and the replacement group.