Comparative Of The Mid-term Effect Of Pure Mitral Regurgitation Reconstruction And Replacement

Objectives: This study aims to investigate the mid-term efficacy of mitral valve reconstruction,MRT(mitral valvuloplasty,MVP)and mitral replacement(MVR)in the treatment of pure mitral regurgitation(PMR).In this study,we compared the mid-term clinical curative effect of MVP and MVR in the treatment of PMR patients to provide clinical evidence-based evidence for the surgical treatment of PMR patients.Methods: This study retrospectively analyzed 524 PMR patient cases from2016 January to 2021 December who underwent mitral valve surgery at the Department of Cardiac Macrovascular Surgery,Yan’an Hospital Affiliated to Kunming Medical University.They were categorized into the MVP group(299 cases)and the MVR group(225 cases)according to their respective surgical procedures.We applied propensity score matching analysis(PSM)to reduce the differences in preoperative baseline characteristics of patients and screened 326 cases(163 cases from each group,the MVP group and the MVR group).Perioperative data of both groups patients were collected,including general data,perioperative cardiac ultrasound data,intraoperative cardiopulmonary bypass time,aortic cross-clamping time,secondary cardiopulmonary bypass,and postoperative chest X-ray,electrocardiogram,color ultrasound and other periodic review results during one week to five years after cardiac operation.The differences in extracorporeal circulation time,aortic block time,postoperative complications,recurrence of regurgitation,reoperation and survival rate between the two groups patients were compared and analyzed.Multivariate Cox analysis was adopted to explore the related factors of postoperative death.Results: PMR patients were categorized into the MVP group(299 cases)and the MVR group(225 cases)based on their respective surgical procedures.There was significant difference between two groups patients in baseline characteristics such as age,preoperative combined atrial fibrillation(AF),and preoperative combined underlying disease.The observed difference achieved statistical significance(p<0.05).Compared with the MVR group patients,the MVP group patients were younger(46.90±14.08 years old vs 50.98±12.88 years old),had smaller left atria(46.86±10.21 mm vs 50.12±10.32mm)and fewer preoperative concomitant diseases(22.4% vs 36.0%).The difference in preoperative baseline characteristics information between the two groups patients were significantly reduced according to propensity score matching analysis,and the baseline characteristics of patients were basically balanced.The extracorporeal circulation diversion time and aortic block time,operative time and secondary diversion rate of MVP group were higher than the MVR group,with statistically difference(p<0.05).However,the early postoperative(30days after surgery)mortality in the MVP group was lower than that in the MVR group(0% vs 2.5%),with statistically difference(p< 0.05).Additionally,the incidence of early postoperative adverse events(5.5% vs 8.0%)and the length of postoperative hospital stay(12.50±5.64 d vs 13.87±6.87d)in the MVP group were lower than those in the MVR group,yet there was no statistically significant difference(p>0.05).The remodeling effect of the left heart structure 5 years after surgery in the MVP group was better than that in the MVR group(LVEDD: 46.75±5.37 mm vs 59.33±11.84mm),with statistically significant difference(p<0.05).In the corresponding period,the right ventricle(RV)of patients underwent tricuspid valvuloplasty(TVP)were significantly smaller after surgery(p<0.05),whereas the right ventricular diastolic diameter did not decrease after surgery in patients without tricuspid valvuloplasty and increased over time(p<0.05).The 5-years reoperation avoidance rate in the MVP group was 98.77%,while there were no cases of reoperation in the MVR group.Kaplan?Meier cumulative risk analysis revealed that the reoperation rate in the MVP group gradually increased along with the extension of time,and the durability of the MVP group was not as superior as the MVR group,which was not statistically significant(p>0.05).A total of 24 complications occurred in these two groups after surgery.The Kaplan-Meier risk analysis revealed that the MVR group had higher complications incidence than the MVP group during 5 years after surgery,and the risk increased with the extension of time(p<0.05).The overall survival rate at 5 years postoperative was higher in the MVP group than in the MVR,at 95.71% and 93.25%respectively,with statistically differences(p<0.05).Multivariate Cox analysis showed that MVP was a protective factor to postoperative death(HR=0.02,p=0.02,95% CI(0.07,0.82)),and preoperative LVEF was an affecting factor to postoperative death(HR=0.95,p=0.03,95% CI(0.91,1.00)).Conclusions:1.Compared with MVR,MVP has longer operation time,longer bypass time,longer aortic cross-clamp time and higher secondary bypass rate,but lower perioperative mortality and better midterm survival.2.MVP and MVR both have great effects on postoperative cardiac remodeling,but MVP is superior to MVR.3.To MR patients with significant tricuspid annulus dilatation,undergo TVP during mitral valve surgery can effectively prevent RV enlarging and better promote cardiac remodeling.4.MVP has a lower incidence rate of postoperative anticoagulation related complications compared with MVR.5.MVP is a protective factor of survive in patients with PMR.