Early-middle Stage Effectiveness Of Non-transplantation Surgical Cardiac Remodeling Operation For End-stage Cardiac Disease

Objective End-stage cardiac disease,a late clinical manifestation of various cardiovascular diseases.With the development of population aging,the incidence rate is increasing year by year,the fatality rate is still high.At present,the methods of treatment for end-stage cardiac disease are limited,the overall curative effect remains poor.Non-transplantation surgical cardiac remodeling operation（A comprehensive treatment of anatomical and functional reconstruction）is still one of the main methods to treat end-stage cardiac disease in most areas.The purpose of this study was to compare the changes of cardiopulmonary function and the scores of the SF-36Questionnaire before and after surgery for patients with end-stage cardiac disease who had non-transplantation surgical cardiac remodeling operation,and to evaluate the clinical efficacy of the operation.To evaluate the clinical effectiveness of non-transplantation surgical cardiac remodeling operation for end-stage cardiac disease by investigating the changes of preoperative and postoperative cardiopulmonary function and the scores of the SF-36 Questionnaire.Methods The clinical data of 51 patients with end-stage cardiac disease were treated by non-transplantation surgical cardiac remodeling operation from February 2010 to July 2016 in the Second Affiliated Hospital of AnHui Medical University was collected.The clinical indexes data of preoperative,early postoperative（leaving from the ICU）,one month after surgery and six months after surgery was compared and analyzed,such as left ventricular end diastolic diameter（LVEDD）,left ventricular end systolic diameter（LVESD）,left atrial diameter（LAD）,left ventricular ejection fraction（LVEF）,pulmonary artery systolic blood pressure（PASP）,cardiothoracic ratio（CTR）and so on.The lung function indexes data of Preoperative,one month after surgery,six months after surgery and twelve months after surgery was compared and analyzed,such as vital capacity（VC）,total lung capacity（TLC）,forced vital capacity（FVC）,maximal voluntary ventilation（MVV）,peak expiratory flow（MEF50）,50%vital gas exhaled volume in one second(FEV_1.0),residual volume（RV）,Carbon monoxide diffusing capacity（DLCO）and so on.The blood gas indexes data of preoperative,one month after surgery,six months after surgery was collected,such as arteriovenous oxygen pressure（PO₂）,arteriovenous carbon dioxide partial pressure（PCO₂）and so on.The data of arteriovenous oxygen difference（P（a-v）O₂）and arteriovenous carbon dioxide partial pressure difference（P（v-a）CO₂）was calculated and compared.The scores of the SF-36 Questionnaire of preoperative,six months after surgery and twelve months after surgery were compared.Results 5 cases of patients were death from postoperative to discharge,the mortality was 9.8 percent.The indexes of cardiothoracic ratio（CTR）,left ventricular end diastolic dimension（LVEDD）,left ventricular end systolic dimension（LVESD）,pulmonary artery systolic pressure（PASP）and left atrium diameter（LAD）were decreased and reduced significantly than these before operation at the early postoperative（leaving from the ICU）and six months after surgery（P<0.01）.The left ventricular ejection fraction（LVEF）was significantly higher than this before operation at one month after surgery and six months after surgery（P<0.01）.The related indicators of lung volume and pulmonary ventilation function were improved significantly at one month after surgery,six months after surgery and twelve months after surgery,such as vital capacity（VC）,total lung volume（TLC）,forced vital capacity（FVC）,maximal ventilatoryvolume（MVV）,maximum expiratoryflowrate of50%vital capacity（MEF50）,50%vital gas exhaled volume in one second(FEV_1.0),residual volume（RV）and so on（P<0.01）,the pulmonary ventilation function index of carbon monoxide diffusing capacity（DLCO）was significantly improved at one month after surgery and six months after surgery（P<0.01）,but there was no significant improvement at six months after surgery and twelve months after surgery（P=0.191）.Thebloodgasindexofarteriovenouscarbondioxidepartialpressure difference（P（v-a）CO₂）was not improved significantly（P=0.276）and the blood gas index of arteriovenous oxygen difference（P（a-v）O₂）was improved significantly at one month after surgery（P<0.01）.The blood gas index of arteriovenous carbon dioxide partial pressure difference（P（v-a）CO₂）was decreased significantly（P<0.01）and the blood gas index of arteriovenous oxygen difference（P（a-v）O₂）was increased significantly at six months after operation（P<0.01）.The scores of the seven dimensions of Physical Function（PF）,Social Function（SF）,Role-Physical（RP）,mental health（MH）,emotional function（RE）,energy（VT）and general health status（GH）in the SF-36Questionnaire were all higher than those of preoperative score at six months after surgery（P<0.01）.However,the score of the dimensions of bodily Pain（BP）in the SF-36 Questionnaire was no significant difference compared with this before the operation（P=0.143）.The scores of the eight dimensions of physical function（PF）,social function（SF）,role-Physical（RP）,mental health（MH）,emotional function（RE）,energy（VT）,bodily pain（BP）and general health status（GH）in the SF-36 Questionnaire were all higher than those of preoperative score at one year after surgery（P<0.01）.Conclusion Non-transplantation surgical cardiac remodeling operation is an effective method to treat end-stage cardiac disease.Although there are many perioperative period complications,cardiac function and lung function indexes of early postoperative are significantly improved compared with those before operation.The improvement is more obvious with the prolongation of postoperative recovery time,especially the quality of life has been significantly improved.It can be used as an effective method for non transplant treatment of end-stage cardiac disease.