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Cox-Maze IV Procedure Concomitant with Valvular Surgery In Situs Inversus Dextrocardia: A Single-Center Experience in China
Published on: February 11, 2022
Heart valve surgery in China: yesterday and today
1Research Institute of Cardiothoracic Surgery of the People's Liberation Army, Department of Cardiothoracic Surgery, Changhai Hospital, Second Military Medical University, Shanghai, China.
Insights
Heart valve surgery in China has advanced significantly, with mitral valve replacement now comprising the majority of procedures. Careful patient selection, particularly regarding mitral calcification, improves surgical outcomes and aligns with international standards.
Area of Science:
- Cardiovascular Surgery
- Medical History
- Public Health
Background:
- Rheumatic heart disease remains the primary cause of valvular damage necessitating surgery in China.
- Historically, mitral valve surgery in China faced high mortality and complications like re-stenosis.
- Significant advancements in heart valve surgery have occurred in China over the past two decades.
Purpose of the Study:
- To review the development and current status of heart valve surgery in China.
- To analyze trends in valvular damage and surgical procedures.
- To assess the impact of patient selection on surgical outcomes.
Main Methods:
- Statistical analysis of historical and recent data on heart valve operations in China.
- Review of surgical techniques and their evolution, from commissurotomy to valve replacement.
- Examination of factors influencing surgical success rates.
Main Results:
- Mitral valve replacement constitutes 60-70% of current valve replacement procedures, with double-valve replacement at 20-25%.
- Absence of mitral calcification is a key factor for higher surgical success rates.
- Heart valve replacement surgery in China has reached international standards in volume and outcomes.
Conclusions:
- Heart valve surgery in China has achieved international standards.
- Continued long-term data collection is crucial for further advancements.
- Optimizing patient selection remains vital for enhancing surgical success in valvular heart disease treatment.
Abstract:
The past 20 years have seen rapid development in heart valve surgery in China. By the late 1990s, there were 6000 heart valve operations performed each year. Statistical analysis has shown that rheumatic heart disease is still the leading cause of valvular damage leading to surgery, as it had been 40 years before. The progressive fibrosis, sclerosis and calcification of the mitral valve that characterises rheumatic heart disease caused high mortality for all forms of mitral valve surgery in China in the 1960s. At that time, the introduction of closed mitral commissurotomy, initially highly effective in alleviating symptoms, was later found to result in re-stenosis in a significant cohort of patients. This was progressively replaced with open mitral commissurotomy. Today, mitral valve replacement represents 60-70% of valvular replacement procedures, followed by double-valve (mitral and aortic) replacement (20-25%). It has been shown both in China and elsewhere that careful selection of patients for an absence of mitral calcification leads to higher success rates for surgery. Heart valve replacement surgery in China now attains international standards in terms of the numbers of cases and surgical outcomes. Further long-term data collection and analysis are essential to aid the further development of the field.
