Analysis Of Clinical Data And Surgical Treatment Of Severe Valvular Heart Dise

Valve surgery in the development of our country has become mature, but some patients the heart of the pathophysiological changes have been developed to a very serious stage in the clinical, despite perioperative management, and improved myocardial protection techniques and cardiac surgical techniques, postoperative complications and mortality was still high, clinically called severe valvular heart disease. Previously reported that the operative mortality can be as high as11.1%to25%[1]. Clinical datas of235cases with severe valvular heart disease from January2002to February2011were analyzed retrospectively, to conduct clinical research, preoperative and postoperative data were evaluated by univariate analysis and multivariate logistic regression analysis, to explore the risk factors for in-hospital mortality of patients with severe valvular heart disease after surgery, and offer the basis in order to prevent it’s occurrence, to explore the risk factors of ventricular arrhythmias following cardiovascular surgery in patients with severe valvular heart diseases, and offer the basis in order to prevent it’s occurrence; to summarize the clinical experience of the surgical treatment of severe valvular heart disease, and analyze the survivors quality of life, to improve the surgical success rate of severe valvular disease, and efforts to improve the quality of life of survivors.The first part:Assessment of in-hospital mortality risk factors in patients with severe valvular heart disease after cardiovascular surgeryObjective To explore the risk factors for in-hospital mortality of patients with severe valvular heart disease after surgery, and offer the basis in order to prevent it’s occurrence. Methods Clinical datas of235cases with severe valvular heart disease from January2002to February2011were analyzed retrospectively. Divided into two groups according to whether or not death after surgery, preoperative and postoperative data were evaluated by univariate analysis and multivariate logistic regression analysis.Results Thirty-two cases died during the hospital and the fatality rate was13.6%. Low cardiac output, multiple organ failure and malignant arrhythmia were the most frequent cause of death. Results in logistic regression method, age≥65years, history of valve>15years, New York Heart Association (NYHA) class IV, cardiothoracic ratio>0.7, left ventricular ejection fraction (LVEF)≤0.4, concomitant coronary artery bypass graft(CABG), and acidosis in postoperative24hours were the independent risk factors for in-hospital mortality after surgery. Conclusion The mortality of severe valvular heart disease after surgery is high and the patients may suffer from many complications. The course of disease, degree of basic pathological change of heart, and perioperative treatment can affect the incidence of postoperative death; early surgery, a positive preoperative preparation, shortening cardiopulmonary bypass time, and maintaining acid-base balance may be the most effective preventive method of death occurred early after cardiovascular surgery.The second part:Risk Factors of Ventricular Arrhythmias Following Cardiovascular Surgery in Patients with Severe Valvular Heart DiseasesObjective To explore the risk factors of ventricular arrhythmias following cardiovascular surgery in patients with severe valvular heart diseases, and offer the basis in order to prevent it’s occurrence. Methods Clinical datas of235cases with severe valvular heart diseases from January2002to February2011were analyzed retrospectively. There were23patients who had ventricular arrhythmia(ventricular arrhythmia group),212patients who had no ventricular arrhythmia as contrast(control group). The preoperative clinical data, cardio pulmonary bypass(CPB), methods of operation, circulatory and electrolyte status of postoperative24hours etc. were choosed, and tested by using χ2test, and logistic regression to analyse the high endangered factors for incidence of ventricular arrhythmia after open heart surgery. Results history of valve>15years, New York Heart Association (NYHA) class IV, left ventricular ejection fraction(LVEF)<0.4, severe tricuspid insufficiency, aortic clamping time≥140min, aorta valve replacement, circulatory failure in postoperative24hours were the independent risk factors of ventricular arrhythmia. Conclusion Ventricular arrhythmia is a severe complication for the patients with severe valvular heart diseases after cardiovascular surgery, and influence the prognosis of the patients. history of valve, degree of basic pathological change of heart, and perioperative management can influence the incidence of ventricular arrhythmias. early operation, shortening of aortic clamping time, and maintaining of normal circulation may be the most effective preventive method of ventricular arrhythmias after cardiovascular surgery.The third part:Clinical experience of the surgical treatment of severe valvular disease and quality of lifeObjective To summarize the clinical experience of the surgical treatment of severe valvular heart disease, and analyze the survivors quality of life. Method235cases with severe valvular heart disease from January2002to February2011were treatmented in department of cardiothoracic surgery, drum tower hospital of nanjing,143cases were male and92cases, female; aged13to80years, the average (51.8±13.1) years. Preoperative New York Heart Association (NYHA) heart function classification grade IV48cases, the X-ray cardiothoracic ratio (CTR) of>0.7in71cases, left ventricular end-diastolic diameter (LVEDD)≥70mm128cases, left ventricular ejection fraction (LVEF)≤0.499cases, severe pulmonary hypertension,106cases,70cases of patients with severe tricuspid regurgitation. Mitral valve replacement (MVR)49,54cases of aortic valve replacement (AVR), mitral valve replacement+aortic valve replacement (DVR) of113cases,19cases of Bentall surgery, concomitant coronary artery bypass grafting (CABG) in49cases. Follow-up time of1-9years, the use of SF-36quality of life analysis. Result During the postoperative hospital stay32patients died, the mortality rate is13.6%, and the leading cause of death were multiple organ failure, postoperative low cardiac output, arrhythmia. The survivors vitality and mental health scores were significantly lower than other cardiac surgery patients (P<0.05). Survival and other cardiac surgery patients were lower than normal in other score, the difference was statistically significant (P<0.05). Conclusion The mortality of severe valvular heart disease after surgery is high and the patients may suffer from many complications. Strengthen the perioperative treatment, proper choice of the timing of surgery, the surgery and postoperative treatment is the key to the treatment of severe valvular heart disease, this can increase the success rate. Survival needs to be improved in vitality and mental health rehabilitation.