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The Journal of Cardiovascular Surgery 2020 August;61(4):496-504

DOI: 10.23736/S0021-9509.20.11212-6


language: English

Early myocardial changes in patients undergoing rheumatic mitral valve repair versus replacement

Yin-Shu CHANG 1, 2, Xu MENG 1 , Yu-Qing JIAO 1, Da-Wei CHANG 3

1 Department of Cardiovascular Surgery, Beijing Anzhen Hospital, Capital Medical University, Beijing, China; 2 Department Cardiovascular Surgery, The First Affiliated Hospital of Xi’an Jiaotong University, Xi’an, China; 3 Faculty of Mathematics and Information Science, Shaanxi Normal University, Xi’an, China

BACKGROUND: Rheumatic mitral valve repair and replacement techniques are frequently used with excellent outcomes in experienced centers. This study aims to evaluate the impact of procedural types on left ventricular function in quinquagenarians.
METHODS: Between January 2018 and September 2019, patients with severe rheumatic mitral stenosis were prospectively recruited. Propensity score matching was performed to reduce the selection bias. We compared the strain, twist and synchrony parameters of left ventricle in 70 quinquagenarian patients who underwent rheumatic mitral valve repair and replacement 12 hours before surgery, at 7 days and 6 months postoperatively.
RESULTS: The overall group displayed significant improvement of left ventricular deformation after rheumatic mitral valve surgery. Compared with patients undergoing posterior chordal-sparing mitral valve replacement, patients undergoing rheumatic mitral valve repair showed more significant amelioration in global longitudinal strain (-18.6% versus -16.2%, P<0.001), twist (18.2° versus 15.9°, P<0.001), torsion (1.8°/cm versus 1.3°/cm, P<0.001), apical rotation (10.5° versus 8.8°, P<0.001), basal rotation (-7.7° versus -7.1°, P=0.049), systolic dyssynchrony index (4.7% versus 5.1%, P=0.021), standard deviation of time to peak longitudinal (46.9 ms versus 49.3 ms, P=0.024) and radial strain (15.8 ms versus 17.1 ms, P=0.037) at 6-month follow-up.
CONCLUSIONS: Rheumatic mitral valve repair might provide patients with better postoperative left ventricular performance than posterior chordal-sparing mitral valve replacement. Longer follow-up is required to compare long-term outcomes.

KEY WORDS: Mitral valve; Ventricular dysfunction, left; Cardiac surgical procedures

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