［Abstract］　Objective　To clarify the safety, efficacy and durability of total thoracoscopic minimally invasive mitral valvuloplasty(TCMI-MVP) in the treatment of mitral regurgitation(MR). Methods　The medium and long term results of 1 275 MR patients who received TCMI-MVP in Guangdong Provincial People′s Hospital from January 1, 2009 to June 1, 2022 were retrospectively analyzed. The patients were divided into non-recurrent MR group(group A, 1 098 cases) and recurrent MR group(group B, 177 cases) according to the follow-up results. The preoperative, intraoperative and postoperative data and the follow-up results were compared between the two groups. Results　The follow-up rate was 96.24%, and the median follow-up time was 4.42(0.00,13.20)years. The 1-, 3-, 5- and 10-year survival rates of the patients in the entire cohort were 99.5%, 98.5%, 97.8% and 95.5%, respectively. There was no significant difference in survival prognosis between the two groups(χ²=0.350, P=0.554). When death was not considered as a competing risk, the recurrent exemption rates of the patients for MR≥2+ at 1 year, 3 years, 5 years and 10 years were 90.4%, 87.4%, 85.6% and 78.3% in the entire cohort, respectively. When death was considered as a competing risk, the cumulative incidence rates of postoperative progression with MR≥2+ at 1 year, 3 years, 5 years and 10 years were 9.6%, 12.5%, 14.3% and 21.4%, respectively. Multivariate Cox regression analysis showed that suffering from high blood pressure［HR(95%CI)=1.70(1.18-2.44), P=0.004］, receiving simultaneous tricuspid valvuloplasty［HR(95%CI)=1.65(1.16-2.36), P=0.006］, larger preoperative left ventricular end-systolic diameter［HR(95%CI)=1.09(1.03-1.15), P=0.002］, larger left atrial diameter 1 week after operation［HR(95%CI)=1.03(1.01-1.06), P=0.031］ and high MR grading 1 week after operation［HR(95%CI)=59.63(21.84-162.82), P<0.001］ were risk factors for MR recurrence. The overall exemption rates of the patients for mitral valve reoperation at 1 year, 3 years, 5 years, and 10 years were 99.6%, 98.9%, 98.7% and 97.9%, respectively. Conclusion　TCMI-MVP is safe and effective in advanced valve centres using various repair techniques in a rational manner, and good long-term repair outcomes can be achieved.]]> 2024/4/3 0:00:00 1, HUANG Yanying^1,2, WANG Zhenzhong¹, XIAO Shuo^3,4, LI Yuxin⁴, FANG Dou⁴, WANG Qiuji⁴, ZHANG Chaolong^2,4, HUANG Huanlei^1,4]]> ZHONG Lishan¹, HUANG Yanying^1,2, WANG Zhenzhong¹, XIAO Shuo^3,4, LI Yuxin⁴, FANG Dou⁴, WANG Qiuji⁴, ZHANG Chaolong^2,4, HUANG Huanlei^1,4 5true ［Abstract］　Objective　To analyze the perioperative results of severe isolated tricuspid valve insufficiency after total thoracoscopic surgery treatment for left heart valve, and to explore the advantages and clinical effects of total thoracoscopic surgery on reoperation for tricuspid valve. Methods　The clinical data of patients with severe isolated tricuspid valve insufficiency after left heart valve surgery who received total thoracoscopic surgery treatment of tricuspid valve in Department of Cardiovascular Surgery, First Medical Center, Chinese PLA General Hospital from January 2018 to December 2023 were retrospectively collected. A total of 134 patients who met the inclusion criteria were included in this study, and their perioperative clinical data and treatment experience were summarized. Among the patients, 72 cases(53.7%) underwent tricuspid valvuloplasty(tricuspid valvuloplasty group) and 62 cases(46.3%) underwent tricuspid valve replacement(tricuspid valve replacement group). The relevant indicators were compared between the two groups. Results　The median time of cardiopulmonary bypass(CPB) in the 134 patients was 92 minutes and the mean operation time was (183.8±56.1)minutes. Two cases(1.5%) had right heart dysfunction after CPB weaning, and received extracorporeal membrane oxygenation(ECMO) support. The weaning was successful within 1 week after surgery. Blood products were transfused in 54 cases(40.3%). After surgery, the median time of ventilator-assisted ventilation was 13.0 hours. The median length of stay in the intensive care unit(ICU) was 2.0 days, and the median time of drainage tube removal was 2.0 days, and the median postoperative thoracic drainage volume was 475.0 mL. Early postoperative complications occurred in 16 cases including ventricular fibrillation in 2 cases, pleural effusion in 4 cases, admission for reoperation in 2 cases and pacemaker implantation in 8 cases. There was no early postoperative death. The pulmonary artery pressure, and the proportion of preoperative atrial fibrillation in the tricuspid valvuloplasty group were lower than those in the tricuspid valve replacement group, and the differences were statistically significant(P<0.05). The operation time, intraoperative plasma transfusion volume, postoperative mechanical ventilation time, length of stay in ICU, postoperative drainage volume, postoperative right atrial diameter, right ventricular end-diastolic diameter, left atrial diameter and the proportion of postoperative complications in the tricuspid valvuloplasty group were lower than those in the tricuspid valve replacement group, and the differences were statistically significant(P<0.05). There were no significant differences in the duration of CPB, intraoperative blood transfusion rate, drainage tube removal time, postoperative left ventricular end-diastolic diameter, postoperative left ventricular ejection fraction, cardiac troponin T on the second day after surgery, creatine kinase isoenzyme MB on the second day after surgery, and the utilization rates of artificial heart assistance devices(including ECMO and intra-aortic balloon pump) between the two groups(P>0.05). Conclusion　CPB with beating-heart for tricuspid valve surgery under total thoracoscopy has the advantages of minimal surgical trauma and quick postoperative recovery. For patients who meet the indications for the surgery, early surgery may lead to a higher probability of receiving tricuspid valvuloplasty and better perioperative outcomes.]]> 2024/4/3 11:46:24 1, HE Xiaoyi^1,2, JIANG Shengli^1,2]]> SHEN Hong¹, HE Xiaoyi^1,2, JIANG Shengli^1,2 4true ［Abstract］　With the trend of population aging and the development of minimally invasive interventional valve replacement technology, there is an increasing demand for valve replacement surgery in elderly and high-risk patients by using interventional approaches. On the basis of summarizing the clinical experience of transapical transcathter aortic valve replacement(TA-TAVR) in the Second Xiangya Hospital of Central South University, combining with the currently available surgical operation norms and reports from relevant units, this paper reviews some common hot issues and difficult problems of TA-TAVR, aiming to provide reference and guidance for clinicians to perform TA-TAVR surgery.]]> 2024/4/3 11:46:24 1, YAO Xingwang², ZHAO Yuan¹]]> ZHOU Kang¹, YAO Xingwang², ZHAO Yuan¹ 3true ［Abstract］　Objective　To compare the surgical outcomes and short-term therapeutic effects between concomitant tricuspid annuloplasty during total thoracoscopic mitral valve replacement and concomitant tricuspid annuloplasty during median sternotomy mitral valve replacement. Methods　The clinical data of 94 patients with functional tricuspid regurgitation(TR) who received concomitant tricuspid annuloplasty during mitral valve replacement in the People′s Hospital of Guangxi Zhuang Autonomous Region from January 2014 to December 2021 were retrospectively analyzed. Among the 94 patients, 68 patients received concomitant tricuspid annuloplasty during median sternotomy mitral valve replacement in beating heart(the median sternotomy group), while 26 patients received concomitant tricuspid annuloplasty during total thoracoscopic mitral valve replacement in beating heart(the total thoracoscopic group). Propensity score matching(PSM) was used to reduce selection bias, and 26 pairs of cases were obtained finally for analysis. The basic information, surgical treatment data and postoperative follow-up data were compared between the two groups, including the results of cardiac color ultrasound and the indicators related to hospitalization due to surgery. Results　The operation time, cardiopulmonary bypass time and aortic cross-clamp time in the total thoracoscopic group was longer than that in the median sternotomy group, and the difference was statistically significant(P<0.05). The results of cardiac color ultrasound examination 1 month after surgery showed that there were no significant differences in mitral systolic blood flow velocity, mitral valve pressure difference, pressure halving time(PHT), area of TR, right atrial diameter(RAD), right ventricular diameter(RVD) and the incidence of atrial fibrillation between the two groups(P>0.05). There was no significant difference in TR recurrence rate 24 months after operation between the two groups(P>0.05). The results of cardiac color ultrasound examination showed that the mitral valve pressure difference in the median sternotomy group was significantly lower than that in the total thoracoscopic group(P<0.05), but there were no significant differences in mitral systolic blood flow velocity, PHT, area of TR, RAD, RVD, left ventricular ejection fraction(LVEF), and the incidence rates of perivalvular leakage, atrial fibrillation and pulmonary arterial hypertension between the two groups 24 months after operation(P>0.05). Conclusion　The effectiveness of concomitant tricuspid annuloplasty during total thoracoscopic mitral valve replacement is equivalent to that of concomitant tricuspid annuloplasty during median sternotomy mitral valve replacement. These two surgical methods can be used for clinical treatment of mitral and tricuspid combined valvular lesions.]]> 2024/4/3 11:46:24 WEI Kequan, LI Sicong, JIANG Wei, HUANG Lijian, QIN Jian, HUANG Zhenwang, LONG Xiaomao 2true ［Abstract］　Objective　To analyze the clinical efficacy and safety of robot-assisted mitral valve replacement for mitral lesions. Methods　The clinical data of 60 patients with mitral lesions who received surgical treatment in the University of Hong Kong-Shenzhen Hospital from July 2020 to February 2023 were retrospectively analyzed. Among the 60 patients, 30 patients who received robot-assisted mitral valve replacement were included in the observation group and 30 patients who received traditional median sternotomy for mitral valve replacement were included in the control group. The therapeutic outcome indicators, clinical outcomes and complications were compared between the two groups. Results　There was no significant difference in connecting time, time for cardiopulmonary bypass support after the aorta was opened and ventilator supporting time between the two groups(P>0.05). The aortic cross-clamp time and operation time in the observation group was longer than that in the control group, and the drainage volume and intraoperative blood loss in the observation group were less than those in the control group, and the wound healing time in the observation group was shorter than that in the control group, and the differences were statistically significant(P<0.05). The improvement rate of clinical outcome was 96.67% in the observation group and 93.33% in the control group, and there were no significant differences between the two groups(P>0.05). The total incidence of complications was 13.33% in the observation group and 10.00% in the control group, and there was no significant difference between the two groups(P>0.05). Conclusion　Robot-assisted mitral valve replacement can effectively improve the therapeutic outcome indicators of the patients with mitral lesions. Its safety is relatively good and worthy of promotion.]]> 2024/4/3 11:46:24 ZHANG Rui, WANG Zanxin, ZHUANG Xianmian, ZHANG Wen, LIU Haibing, CHEN Bailang, YAO Shihua, LI Jianfeng, WEI Minxin 1true