保留二尖瓣瓣下结构二尖瓣膜置换手术对心功能、瓣膜功能的影响及并发症

doi:10.3969/j.issn.1006-5725.2024.15.008

Abstract

Abstract:

Objective To investigate the effects and complications of mitral valve membrane replacement surgery with preservation of mitral valve subvalvular structure on cardiac and valve function. Methods A total of 84 patients receiving mitral valve membrane replacement surgery with preserved mitral valve subvalvular structure in the First Affiliated Hospital of Soochow University from August 2019 to July 2022 were selected as the observation group， and 68 patients receiving mitral valve membrane replacement surgery without preservingmitral valve subvalvular structure were selected as the control group. The surgical indicators， comorbidities， preoperative and postoperative cardiac function，and mitral valve hemodynamic parameters were compared between the two groups. Results There was no statistically significant difference between the observation group and the control group in terms of surgical history， extracorporeal circulation time， aortic occlusion time， postoperative mechanical ventilation time， ICU retention time， and postoperative hospitalization time （P > 0.05）. At 1， 3， and 6 months after surgery， the left ventricular end systolic diameter （LVESD） and left ventricular end diastolic diameter （LVEDD） in the observation group were significantly lower than those in the control group （P < 0.05）， while the left ventricular short axis shortening rate （LVFS） was significantly higher than that in the control group （P < 0.05）. There was no statistically significant difference in left ventricular ejection fraction （LVEF） between the observation group and the control group at 1， 3， and 6 months after surgery （P > 0.05）. There was no statistically significant difference （P > 0.05） in the peak mitral valve velocity （Vmax）， maximum pressure gradient difference （PGmax）， and mean pressure gradient difference （PGmean） between the observation group and the control group at 1， 3， and 6 months after surgery. There was no statistically significant difference in creatine kinase isoenzyme （CK-MB） and N-terminal precursor brain natriuretic peptide （NT-proBNP） between the observation group and the control group at 1， 3， and 6 months after surgery （P > 0.05）. There was no statistically significant difference in the incidence of postoperative complications between the observation group and the control group （P > 0.05）. Conclusion The preservation of the mitral valve subvalvular structure and mitral membrane replacement surgery improved patient cardiac function， while there was no significant difference in mitral valve orifice blood flow parameters and complications compared with surgery without preservation of the mitral valve subvalvular structure.

Key words: mitral valve, subvalvular structure, mitral valve membrane replacement surgery, cardiac function, complications

CLC Number:

R542.5

Yihuan CHEN,Zhenya SHEN,Yunsheng YU,Haoyue HUANG,Wenxue YE,Fei HUA,Yanqiu. HU. Observation on the effects and complications of mitral valve membrane replacement surgery with preservation of mitral valve subvalvular structure on cardiac function and valve function[J]. The Journal of Practical Medicine, 2024, 40(15): 2092-2097.

Figures/Tables 9

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References 20

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指标	观察组（n = 84）	对照组（n = 68）	t/χ²值	P值
性别			1.066	0.563
男	34（40.48）	22（32.35）
女	50（59.52）	46（67.65）
年龄（x ± s，岁）	46.69 ± 15.54	45.28 ± 14.12	0.579	0.563
NYHA心功能分级			0.454	0.500
Ⅲ	68（80.95）	52（76.47）
Ⅳ	16（19.05）	16（23.53）

指标	观察组（n = 84）	对照组（n = 68）	t值	P值
手术时间（h）	3.22 ± 0.83	3.10 ± 0.94	0.835	0.405
体外循环时间（min）	72.21 ± 10.43	70.04 ± 11.67	1.209	0.228
主动脉阻断时间（min）	45.50 ± 9.94	42.28 ± 10.02	1.979	0.050
术后机械通气时间（h）	30.20 ± 9.91	29.83 ± 9.53	0.233	0.816
ICU滞留时间（d）	4.82 ± 0.92	4.70 ± 0.98	0.777	0.439
术后住院时间（d）	10.73 ± 2.24	10.95 ± 2.17	-0.611	0.542

指标	组别	术前	术后1个月	术后3个月	术后6个月
LVESD（mm）	观察组（n = 84）	38.93 ± 2.93	33.02 ± 4.83^?#	32.01 ± 4.02^?#	31.12 ± 3.82^?#
LVESD（mm）	对照组（n = 68）	39.01 ± 3.11	35.56 ± 4.23^?	34.45 ± 4.17^?	33.17 ± 4.03^?
	F_{时间×组间} = 9.922，F_时间 = 5.032，F_组间 = 3.849
	P_{时间×组间} < 0.001，P_时间 < 0.001，P_组间 < 0.001
LVEDD（mm）	观察组（n = 84）	51.17 ± 4.03	44.85 ± 3.92^?#	43.31 ± 4.05^?#	43.01 ± 3.87^?#
LVEDD（mm）	对照组（n = 68）	51.80 ± 3.88	47.29 ± 4.01^?	46.68 ± 3.88^?	46.12 ± 3.90^?
	F_{时间×组间} = 10.023，F_时间 = 5.783，F_组间 = 4.023
	P_{时间×组间} < 0.001，P_时间 < 0.001，P_组间 < 0.001
LVEF（%）	观察组（n = 84）	57.93 ± 5.00	61.21 ± 4.87^?	61.83 ± 4.66^?	61.90 ± 4.52^?
LVEF（%）	对照组（n = 68）	57.10 ± 4.88	60.82 ± 5.01^?	61.12 ± 5.02^?	61.44 ± 4.96^?
	F_{时间×组间} = 1.921，F_时间 = 4.483，F_组间 = 1.019
	P_{时间×组间} = 0.334，P_时间 < 0.001，P_组间 = 0.552
LVFS（%）	观察组（n = 84）	31.19 ± 2.83	34.84 ± 2.70^?#	36.14 ± 2.85^?#	36.43 ± 2.90^?#
LVFS（%）	对照组（n = 68）	31.07 ± 2.90	33.22 ± 2.65^?	33.65 ± 2.90^?	33.98 ± 2.67^?
	F_{时间×组间} = 11.201，F_时间 = 6.034，F_组间 = 4.118
	P_{时间×组间} < 0.001，P_时间 < 0.001，P_组间 < 0.001

指标	组别	术前	术后1个月	术后3个月	术后6个月
Vmax（cm/s）	观察组（n = 84）	165.43 ± 21.24	120.45 ± 19.98^?	119.92 ± 23.32^?	118.12 ± 22.43^?
Vmax（cm/s）	对照组（n = 68）	163.38 ± 20.44	121.18 ± 20.15^?	120.04 ± 21.22^?	119.40 ± 21.15^?
	F_{时间×组间} = 1.021，F_时间 = 6.011，F_组间 = 1.821
	P_{时间×组间} = 0.667，P_时间 = 0.000，P_组间 = 0.354
PGmax（mmHg）	观察组（n = 84）	18.29 ± 2.91	13.34 ± 2.02^?	13.04 ± 2.12^?	12.98 ± 2.06^?
PGmax（mmHg）	对照组（n = 68）	18.10 ± 3.10	13.82 ± 2.15^?	13.14 ± 2.40^?	13.06 ± 2.11^?
	F_{时间×组间} = 0.982，F_时间 = 6.021，F_组间 = 1.122
	P_{时间×组间} = 0.880，P_时间 = 0.000，P_组间 = 0.565
PGmean（mmHg）	观察组（n = 84）	7.83 ± 1.02	5.34 ± 1.00^?	5.12 ± 0.98^?	5.02 ± 0.93^?
PGmean（mmHg）	对照组（n = 68）	7.95 ± 1.01	5.50 ± 1.04^?	5.24 ± 1.00^?	5.11 ± 0.98^?
	F_{时间×组间} = 1.003，F_时间 = 5.501，F_组间 = 1.992
	P_{时间×组间} = 0.683，P_时间 = 0.000，P_组间 = 0.312

组别	CK-MB（ng/mL）		NT-proBNP（pg/mL）
组别	术前	术后7 d	术前	术后7 d
观察组（n = 84）	30.13 ± 4.65	12.21 ± 2.81*	189.29 ± 23.32	110.20 ± 20.03*
对照组（n = 68）	29.18 ± 4.12	12.91 ± 2.77*	191.40 ± 22.15	114.49 ± 19.82*
t值	1.317	-1.537	-0.567	-1.319
P值	0.190	0.126	0.571	0.189

Observation on the effects and complications of mitral valve membrane replacement surgery with preservation of mitral valve subvalvular structure on cardiac function and valve function

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项目	观察组（n = 84）	对照组（n = 68）	χ²值	P值
肺部感染	2（2.38）	3（4.41）	0.988	0.32
阵发性快速房颤	1（1.19）	2（2.94）
迟发性心包积液	1（1.19）	2（2.94）
总并发症发生率	4（4.76）	7（10.29）

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