Mitral valve repairment for mitral regurgitation due to infective endocarditis

doi:10.3877/cma.j.issn.1674-1358.2019.01.008

Abstract

Abstract:

Objective

To investigate the effect of mitral valve repairment and replacement on mitral regurgitation caused by infective endocarditis.

Methods

Total of 126 patients with mitral regurgitation caused by infective endocarditis were selected from January 2014 to January 2016 in Zibo Central Hospital, who were divided into study group and control group (63 cases in each group) according to different operation methods. Patients in the study group were treated with mitral valve repairment and patients in the control group were treated with mitral valve replacement. The periods of endotracheal intubation and intensive care unit (ICU) hospitalization, the incidence of infection, the fatality rate, the period and the cost of hospitalization of the 126 patients were recorded in detail, respectively. The results of echocardiography in patients for left ventricular ejection fraction, left ventricular end-diastolic diameter, left ventricular end-systolic diameter, left atrial diameter and mitral regurgitation score were recorded, respectivly.

Results

Tracheal intubation period [(16.48 ± 8.06) h], ICU hospitalization period [(2.12 ± 0.86) h], postoperative mortality rate (1.59%), hospitalization period [(22.46 ± 10.34) d], incidence of embolism (4.76%) and hospitalization cost [(10.63 ± 3.57) ten thousand yuan] of the study group were lower than those of the control group, with significant differences (t = 1.35, P = 0.04; t = 3.68, P = 0.02; χ² = 4.67, P = 0.01; t = 4.03, P = 0.01; χ² = 1.69, P = 0.04; t = 3.06, P = 0.03). The left ventricular ejection fraction [(49.06 ± 10.24)%], left atrial diameter [(43.25 ± 8.98) mm] and mitral regurgitation score [(1.12 ± 0.31)] of patients in study group were lower than those in the control group, while left ventricular end-diastolic diameter [(52.46 ± 7.42) mm] and left ventricular end-systolic diameter [(39.70 ± 8.09) mm] of patients in study group were larger than those of control group, all with significant differents (t = 1.23, 2.84, 3.89, 1.34, 2.01; P = 0.04, 0.02, 0.01, 0.03, 0.02). Following-up showed that left ventricular ejection fraction of patients in the study group (61.38 ± 8.61)% was higher than that of the control group (t = 5.31, P = 0.01); but left ventricular end-diastolic diameter [(48.69 ± 9.57) mm] and follow-up mortality (4.76%) were lower than those of the control group, with significant differences (t = 3.24, P = 0.02; χ² = 2.91, P = 0.03). Univariate analysis of variance showed that ICU hospitalization period, intubation period and history of heart failure were all risk factors of operative death for patients with infective endocarditis (t = 2.34, P = 0.01; t = 1.09, P = 0.03; χ² = 1.61, P = 0.02).

Conclusions

Mitral valve repairment is effective in the treatment of mitral regurgitation caused by infective endocarditis, which could shorten the hospitalization period and reduce the cost of mitral valve regurgitation.

Key words: Mitral valve repair, Infective endocarditis, Mitral regurgitation, Mitral valve replacement

Gang Ma, Shuting Bi. Mitral valve repairment for mitral regurgitation due to infective endocarditis[J]. Chinese Journal of Experimental and Clinical Infectious Diseases(Electronic Edition), 2019, 13(01): 37-42.

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组别	例数	男/女（例）	年龄（±s，岁）	体质量（±s，kg/m²）	术前抗菌药物使用时间（±s，d）
研究组	63	48/15	38.22± 12.06	21.6 ± 2.2	22.98 ± 16.56
对照组	63	46/17	36.89± 10.85	22.8 ± 2.4	23.61 ± 14.57
统计量	?	χ²= 0.15	t= 0.09	t= 0.86	t= 0.05
P值	?	0.68	0.77	0.59	0.93

组别	例数	男/女（例）	年龄（±s，岁）	体质量（±s，kg/m²）	术前抗菌药物使用时间（±s，d）
研究组	63	48/15	38.22± 12.06	21.6 ± 2.2	22.98 ± 16.56
对照组	63	46/17	36.89± 10.85	22.8 ± 2.4	23.61 ± 14.57
统计量	?	χ²= 0.15	t= 0.09	t= 0.86	t= 0.05
P值	?	0.68	0.77	0.59	0.93

指标	对照组（63例）	研究组（63例）	统计量	P值
体外循环时间（x ± s，min）	124.25 ± 48.62	111.47 ± 42.23	t = 0.32	0.21
主动脉阻断时间（x ± s，min）	92.78 ± 32.35	81.84 ± 30.06	t = 0.30	0.24
气管插管时间（x ± s，h）	28.36 ± 10.25	16.48 ± 8.06	t = 1.35	0.04
入住ICU时间（x ± s，d）	2.98 ± 1.06	2.12 ± 0.86	t = 3.68	0.02
二次开胸[例（%）]	4（6.35）	3（4.76）	χ² = 0.11	0.60
心功能衰竭[例（%）]	7（11.11）	6（9.52）	χ² = 0.23	0.55
脓毒症[例（%）]	2（3.17）	1（1.59）	χ² = 0.22	0.51
伤口感染[例（%）]	3（4.76）	2（3.17）	χ² = 0.38	0.25
主动脉内球囊反搏[例（%）]	31（49.21）	39（61.90）	χ² = 0.16	0.16
栓塞[例（%）]	14（22.22）	3（4.76）	χ² = 1.69	0.04
术后病死率[例（%）]	4（6.35）	1（1.59）	χ² = 4.67	0.01
住院天数（x ± s，d）	28.73 ± 11.34	22.46 ± 10.34	t = 4.03	0.01
住院花费（x ± s，万元）	13. 51 ± 4.46	10.63 ± 3.57	t = 3.06	0.03

指标	对照组（63例）	研究组（63例）	统计量	P值
体外循环时间（x ± s，min）	124.25 ± 48.62	111.47 ± 42.23	t = 0.32	0.21
主动脉阻断时间（x ± s，min）	92.78 ± 32.35	81.84 ± 30.06	t = 0.30	0.24
气管插管时间（x ± s，h）	28.36 ± 10.25	16.48 ± 8.06	t = 1.35	0.04
入住ICU时间（x ± s，d）	2.98 ± 1.06	2.12 ± 0.86	t = 3.68	0.02
二次开胸[例（%）]	4（6.35）	3（4.76）	χ² = 0.11	0.60
心功能衰竭[例（%）]	7（11.11）	6（9.52）	χ² = 0.23	0.55
脓毒症[例（%）]	2（3.17）	1（1.59）	χ² = 0.22	0.51
伤口感染[例（%）]	3（4.76）	2（3.17）	χ² = 0.38	0.25
主动脉内球囊反搏[例（%）]	31（49.21）	39（61.90）	χ² = 0.16	0.16
栓塞[例（%）]	14（22.22）	3（4.76）	χ² = 1.69	0.04
术后病死率[例（%）]	4（6.35）	1（1.59）	χ² = 4.67	0.01
住院天数（x ± s，d）	28.73 ± 11.34	22.46 ± 10.34	t = 4.03	0.01
住院花费（x ± s，万元）	13. 51 ± 4.46	10.63 ± 3.57	t = 3.06	0.03

组别		例数	左心室射血分数（%）	左心室舒张末期直径（mm）	左心室收缩末期直径（mm）	左心房直径（mm）	二尖瓣反流得分（分）
手术前		?	?	?	?	?	?
?	研究组	63	49.85 ± 11.34	59.38 ± 6.85	44.16 ± 8.06	53.46 ± 9.95	3.57 ± 0.43
?	对照组	63	52.35 ± 11.06	58.86 ± 6.43	42.32 ± 7.61	55.52 ± 9.53	3.68 ± 0.44
t值		?	0.65	0.08	0.45	0.71	0.86
P值		?	0.35	0.87	0.33	0.18	0.10
手术后		?	?	?	?	?	?
?	研究组	63	49.06 ± 10.24	52.46 ± 7.42	39.70 ± 8.09	43.25 ± 8.98	1.12 ± 0.31
?	对照组	63	51.79 ± 9.86	50.87 ± 6.33	37.35 ± 7.16	46.65 ± 8.87	1.52 ± 0.33
t值		?	1.23	1.34	2.01	2.84	3.89
P值		?	0.04	0.03	0.02	0.02	0.01

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