Abstract
Purpose The prognosis of mitral valve replacement is an important clinical issue and may produce unexpected mortality rates if not properly addressed. The postoperative examination results have important prognostic implications. This study was designed to determine the prognostic value of phosphocreatine and inflammatory markers after mitral valve replacement. Method Comparison and analysis of the data obtained using SPSS software. The computer retrieved PubMed, Science Citation Index (SCI), Embase, VIP, CNKI, CBM, and Wanfang database and manually retrieved randomized controlled trials (RCTs) published at home and abroad on the central muscle protection role of creatine phosphate in heart valve replacement, and the search period was established until February 2018. Two random literature reviewers independently screened the literature and extracted data, using Review Manager (RevMan) (Computer program), version 5.3 (The Nordic Cochrane Centre, The Cochrane Collaboration, Copenhagen, 2014). RevMan software version 5.0 assesses the risk of bias for inclusion in studies. The software performs a meta-analysis of the obtained data. Results Ten RCTs with a total of 464 participants were enrolled. The meta-analysis results showed that (1) elevated creatine kinase levels often predict a better prognosis after mitral valve replacement (RR = 1.36, 95% CI: 1.22 to 1.52, P < 0.00001), (2) the creatine kinase isoenzyme level in the venous blood of the phosphocreatine group after 24 h of aortic blocking was significantly lower than that in the control group (SMD = −2.90, 95% CI: -5.19 to -0.60, P = 0.01), and (3) Troponin I levels were significantly lower in the intravenous creatine group than in the control group 24 h after opening of the aortic block (SMD = −1.49, 95% CI: -2.02 to -0.97,P < 0.00001). Conclusions Creatine phosphate and inflammatory factor have good predictive value for the prognosis of mitral valve replacement.
Highlights
Mitral stenosis usually progresses slowly, with an average annual decrease in mitral orifice area of 0.01 cm2
Medical treatment can only be for atrial fibrillation and the prevention of thromboembolic comorbidities and cannot reverse the pathological changes of the valves, and the early stage of the lesion can be achieved by valvuloplasty can obtain satisfactory efficacy, but when the lesion is serious, only valve replacement can be used, and mitral valve replacement is still an effective means of treating rheumatic mitral stenosis, which can significantly alleviate clinical symptoms and improve cardiac function [2, 3]
There was no statistical heterogeneity between the groups, fixed-effect model was used, and the results showed that the intraoperative cardiac autorepulsion rate in the creatine phosphate group was significantly higher than that in the control group (1.36, 95% confidence interval (95% CI): 1.22-1.52, P < 0:00001), see Figure 3.The levels of serum IL-6 and IL-10 after operation were significantly lower than those before operation, and the level of IL-10 was higher than that before operation (P < 0:05), The score of postoperative quality of life in this group was significantly higher than that before operation (P < 0:05)
Summary
Mitral stenosis usually progresses slowly, with an average annual decrease in mitral orifice area of 0.01 cm. Because of its insidious onset and long course of disease, it is difficult to detect in time, which affects early treatment and often progresses to chronic or even severe valvular heart disease [1] For such diseases, medical treatment can only be for atrial fibrillation and the prevention of thromboembolic comorbidities and cannot reverse the pathological changes of the valves, and the early stage of the lesion can be achieved by valvuloplasty can obtain satisfactory efficacy, but when the lesion is serious, only valve replacement can be used, and mitral valve replacement is still an effective means of treating rheumatic mitral stenosis, which can significantly alleviate clinical symptoms and improve cardiac function [2, 3].
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