Application of Commissural Plasty in the Majority of Rheumatic Mitral Repairs: Surgical Experiences and Results of Mid-term Follow-up in Chinese Population
- #AC/VAL 01-EP-6
- Adult Cardiac Surgery/Valves. E-POSTER (ORAL) SESSION 1
- E-Poster (oral)
Application of Commissural Plasty in the Majority of Rheumatic Mitral Repairs: Surgical Experiences and Results of Mid-term Follow-up in Chinese Population
Tiange Luo, Xu Meng
Beijing Anzhen Hospital, Capital Medical University-Beijing Institute of Heart Lung and Blood Vessel Diseases, Beijing, China
Date, time and location: 2018.05.25 10:30, Exhibition area, 1st Floor. Zone – D
Abstract
Objective: In the present study,we aimed to retrospectively evaluate our experience and mid-term follow-up results of commissural plasty application in a majority of Chinese patients who had undergone rheumatic mitral valve repair at our centre to assess the therapeutic effect of this technique.
Methods: We assessed the past 7-year medical record of our centre for obtaining a comprehensive follow-up data of patients who had undergone rheumatic mitral valve repair.We constructed the Kaplan–Meier survival curve for freedom from reoperation and valve failure.Furthermore, using the multivariate Cox regression analyses,we identified predictive factors for all endpoints in the follow-up period.
Results: In this study, 349 patients (women:76.5%,267/349) underwent rheumatic mitral valve repair at our centre from January 2011 to September 2017.The mean age was 52±11 years(18–75 years).The primary preoperative pathological feature was mitral valve stenosis.A majority of surgeries at our centre comprised commissural plasty in collaboration with other surgical techniques.In the follow-up period,we observed 27 endpoint events(18 patients,moderate or severe regurgitation;6 patients,mitral valve restenosis). Seven patients required reoperation. Two patients died of cerebral hemorrhage and cardiac failure,respectively. Two patients had infective endocarditis. Seven patients required reoperationThe proportion of freedom from reoperation and valve failure over 6 years and within 2 years in the follow-up period was 89.3%±2.3% and 91.3%±1.9%,respectively. For all 349 patients,the postoperative echocardiographic indexes at 3 months after the operation(mitral valve orifice area;E-wave;mitral valve mean transmitral pressure gradients) improved notably compared with the preoperative values (2.42±0.35 vs 1.43±0.57cm2, 135.25±28.01 vs 189.56±47.65cm/s, 7.65±3.20 vs 15.28±7.77mmHg). The same echocardiographic indexes at 12 months for 216 patients and 48 months for 40 patients after the operation were not remarkably different (2.34±0.47cm2 and 2.22±0.52cm2, 141.93±31.94cm/s and 156.56±41.45cm/s, 8.46±3.81mmHg and 9.35±4.88mmHg). Multivariate Cox regression analysis revealed that the left atrial anterior and posterior diameter(LAAPD)>60mm (HR,2.715;P=0.00) was significant risk predictors for all endpoints.
Conclusions: In conclusion, the pathological features of Chinese patients facilitate the effective treatment of a majority of rheumatic mitral repair patients through commissural plasty in association with other surgical techniques. Hence, this study considers the median follow-up results of rheumatic mitral repair as satisfactory.