Mitral valve repair and mitral valve replacement in the treatment of infective endocarditis mitral valve regurgitation in the long-term curative effect comparison
10.3760/cma.j.issn.1001-4497.2017.07.007
- VernacularTitle:二尖瓣修复术和二尖瓣置换术治疗感染性心内膜炎二尖瓣反流的中远期疗效比较
- Author:
Tianyu ZHOU
;
Jun LI
;
Hao LAI
;
Yongxin SUN
;
Haiyan CHEN
;
Wenjun DING
;
Tao HONG
;
Chunsheng WANG
- Keywords:
Infective endocarditis;
Mitral regurgitation;
Mitral valve repair;
Mitral valve replacement
- From:
Chinese Journal of Thoracic and Cardiovascular Surgery
2017;33(7):408-412
- CountryChina
- Language:Chinese
-
Abstract:
Objective The aim of the study was to compare the mid-and long-term results between mitral valve repair and mitral valve replacement in mitral regurgitation due to infective endocarditis.Methods From January 2005 to December 2014, 225 patients with mitral regurgitation due to infective endocarditis underwent surgical treatment at our institution.159 patients(70.7%) were male, and the mean age was(42±15) years(13-76 years).Among them, mitral valve repair was performed in 89 patients(repair group) and mitral valve replacement in 136 patients(replacement group).Preoperative clinical profiles, perioperative details and follow-up data were reviewed retrospectively.Results There was no operative death in both groups.Compared to replacement group, patients undergoing mitral valve repair suffered significantly less embolism events(9.0% vs.22.8%, P<0.05) and central nerve complications(6.7% vs.17.6%, P<0.05).Patients with mitral valve vegetation were significantly less in repair group as well(59.6% vs.89.0%, P<0.05).The mean cardiopulmonary bypass time[(87±30) min vs.(86±33) min, P>0.05] and aorta clamp time[(52±21) min vs.(51±23) min, P>0.05]were similar between repair group and replacement group.Intensive care stay was significantly shorter in repair group[(1.4±0.7)days vs.(1.9±1.3)days, P<0.05] and hospital stay was shorter in repair group as well[(8.3±4.5)days vs.(9.5±5.3)days, P=0.09].Perioperative cerebral hemorrhage was observed in no patient in repair group and 2 patients(1.5%) in replacement.There was no in-hospital death in repair group.2 in-hospital(1.5%) deaths occurred in replacement group and the causes of death were cerebral hemorrhage and low cardiac output syndrome.The mean follow-up time was(40±35) months(3-134 months), and follow-up was complete in 85% patients.10 years over follow-up, freedom from heart related adverse events was 88% in repair group and 86% in replacement group(P>0.05).Conclusion Mitral valve repair was safe and feasible in mitral regurgitation due to infective endocarditis, with good mid-and long-term outcomes.Thorough excision of infective tissue and vegetation was necessary to perform mitral valve repair.Yet mitral valve replacement was a viable option in patients for whom repair was infeasible due to severe damage of valve.
