| 【 Objective 】 To study the long-term prognosis of left ventricular valve replacement and to explore the risk factors and clinical strategies for prognosis.【Methods】This study was a single-center long-term retrospective study of 264 patients undergoing left ventricular valve replacement at Tongji Hospital affiliated to Tongji Medical College of Huazhong University of Science and Technology from2005 to 2007.The patients were followed up for MACE events(Major Adverse Cardiovascular Events)included death,hospitalization for heart failure,stroke,long-term medication regimen,assessment of New York Heart Association(NYHA)functional status.At follow-up we collected echocardiography to assess long-term cardiac remodeling after left ventricular valve replacement.Then we studied the risk factors that influence prognosis and explored the corresponding clinical strategies.【 Results 】 1.Patients with left ventricular valve replacement in the long-term(greater than 10 years,an average of 10.41 ± 1.47 years)follow-up: a total of 264 patients with mitral,aortic or double valve replacement surgery patients were discharged.257 follow-up data were collected,with a follow-up rate of 97.35%,48deaths(all-cause mortality rate was 18.7%),8.1% re-admission rate for heart failure,and 10% re-admission rate for stroke.NYHA functional status in long-term survivors was as follows: grade I 47.6%,grade II 31.1%,grade III 18.4%,grade IV 2.9%,The rate of heart failure significantly limiting the patient’s daily physical activities was21.3%(NYHA functional status III + IV).Long-term medication regimen: 108 people with warfarin(96.7%),28 patients with beta blockers(13.4%),11 patients with renin-angiotensin system inhibitor(5.3%),14 patients with loop diuretics(6.7%),and 19 patients with aldosterone antagonist spironolactone(9.1%).2.Echocardiography study of long-term cardiac remodeling after left ventricular valve replacement: preoperative to postoperative,left atrial anteroposterior diameter(mm)(48.00 ± 13.98 vs.39.68 ± 9.48,p < 0.001),left ventricular end diastolic diameter (mm)(55.67±13.18 vs.47.90±8.33,<0.001)and the tricuspid regurgitation pressure gradient(mm Hg)(43.72±18.55 vs.26.05±8.53,p<0.001)were significantly improved;In the long-term,the left atrium anteroposterior diameter(mm)(39.68 ± 9.48 vs.49.02 ± 14.32,p < 0.001),tricuspid regurgitation(TR)(1.41 ± 0.95 vs 2.15 ± 1.16,p< 0.001)has progressed significantly.The left atrium anteroposterior diameter(LA)≥ 50 mm(p = 0.011)and TR > 2(p = 0.012)were associated with poor prognosis of NYHA functional status III + IV.3.Time-dependent changes in LA and TR after left ventricular valve replacement: LA and TR scatterplots showed that LA and TR had an upward trend in the long-term compared with postoperative baseline,and progressively worsened with time.In order to further clarify the time trend,we compared the groups of postoperative baseline,postoperative ≤ 9 years,postoperative ≥ 10 years.LA increased 6.34 mm from baseline 39.68 mm to 46.02 mm in postoperative ≤ 9 years(p =0.026),then increased6.12 mm from 46.02 mm in postoperative ≤ 9 years to 52.14 mm in postoperative ≥10years(p =0.043);TR>2 percentage increased by 19% from baseline 2% to 21% in postoperative ≤9 years(p = 0.023),then increased rapidly by 22% from 21% in postoperative ≤ 9 year to 43% in postoperative ≥ 10 years(p = 0.008).It is suggested that postoperative cardiac remodeling is time-dependent,and cardiac remodeling is increasing with time.【 Conclusion 】 The progression of LA and TR after left ventricular valve replacement is associated with poor prognosis and cardiac dysfunction in long-term patients,and therefore can be used as a predictor of cardiac remodeling and early cardiac dysfunction.The progression of LA and TR is time-dependent,means that heart remodeling continues to increase over time.It is necessary to pay attention to explore long-term cardioprotective treatment after left ventricular valve replacement. |
PDF Full Text Request