Hou Ming, Zhou Wei, Zhang Ning
Department of Cardiac Macrovascular Surgery, Affiliated Hospital of North Sichuan Medical College, Nanchong, Sichuan, China.
Department of Cardiothoracic Surgery, Dazhou Dachuan District People's Hospital (Dazhou Third People's Hospital), Dazhou, Sichuan, China.
Front Cardiovasc Med. 2025 Aug 15;12:1635587. doi: 10.3389/fcvm.2025.1635587. eCollection 2025.
The main types of surgery for rheumatic mitral valve disease are traditional percutaneous mitral balloon valvuloplasty (PMBV), mitral valve replacement (MVR) with removal of the original valve, and valve repair with preservation of the original valve. Some studies have shown that mitral valve repair (MVr) has certain advantages compared with replacement.
The clinical data of 166 patients with rheumatic mitral valve lesions admitted to the Department of Cardiac Macrovascular Surgery of the and the were retrospectively analyzed to compare the hemodynamic changes after mitral valve repair and replacement.
Hemodynamic evaluation of MVr: (1) left ventricular end-diastolic diameters (LVEDD), left atrial end-systolic diameters (LAESD), mitral E-wave velocity, left ventricular ejection fraction (LVEF), mitral valve orifice area (MVOA), mitral pressure halving time (PHT), and mean pressure gradient (MPG) at each time point after MVr were improved compared with preoperative values ( < 0.05). (2) There was a significant improvement in the level of mitral regurgitation in MVr patients intraoperatively and at the time of discharge compared with preoperatively ( < 0.05). Hemodynamic evaluation of MVr and MVR: (1) Patients who underwent MVr had significantly lower LVEDD, LAESD, and mitral E-wave velocity than those of patients who underwent MVR at each postoperative time point ( < 0.05). (2) Patients who underwent MVr had lower left ventricular posterior wall thickness at end-diastole (LVPWd) than that of patients who underwent MVR at 3 and 6 months postoperatively ( < 0.05). (3) Patients who underwent MVr had lower LVEF than that of patients who underwent MVR at 6 months postoperatively ( < 0.05). (4) Patients who underwent MVr had lower left ventricular end-diastolic volume (LVEDV) than that of patients who underwent MVR at 3 months postoperatively ( < 0.05).
Mitral valve repair and mitral valve replacement are effective in the treatment of patients with rheumatic mitral valve disease, with greater hemodynamic improvement after mitral valve repair than replacement and with greater short-term clinical efficacy than valve replacement.
风湿性二尖瓣疾病的主要手术类型包括传统经皮二尖瓣球囊成形术（PMBV）、切除原瓣膜的二尖瓣置换术（MVR）以及保留原瓣膜的瓣膜修复术。一些研究表明，二尖瓣修复术（MVr）与置换术相比具有一定优势。
回顾性分析 [医院名称1] 和 [医院名称2] 心脏大血管外科收治的166例风湿性二尖瓣病变患者的临床资料，比较二尖瓣修复术和置换术后的血流动力学变化。
二尖瓣修复术的血流动力学评估：（1）二尖瓣修复术后各时间点的左心室舒张末期内径（LVEDD）、左心房收缩末期内径（LAESD）、二尖瓣E波速度、左心室射血分数（LVEF）、二尖瓣口面积（MVOA）、二尖瓣压力减半时间（PHT）和平均压力阶差（MPG）与术前相比均有改善（P < 0.05）。（2）二尖瓣修复术患者术中及出院时二尖瓣反流程度与术前相比有显著改善（P < 0.05）。二尖瓣修复术与二尖瓣置换术的血流动力学评估：（1）二尖瓣修复术患者术后各时间点的LVEDD、LAESD和二尖瓣E波速度均显著低于二尖瓣置换术患者（P < 0.05）。（2）二尖瓣修复术患者术后3个月和6个月的舒张末期左心室后壁厚度（LVPWd）低于二尖瓣置换术患者（P < 0.05）。（3）二尖瓣修复术患者术后6个月的LVEF低于二尖瓣置换术患者（P < 0.05）。（4）二尖瓣修复术患者术后3个月的左心室舒张末期容积（LVEDV）低于二尖瓣置换术患者（P < 0.05）。
二尖瓣修复术和二尖瓣置换术对风湿性二尖瓣疾病患者均有效，二尖瓣修复术后血流动力学改善程度大于置换术，且短期临床疗效优于瓣膜置换术。
