Surgical Treatment Of Senile Heart Valvular Diseases

Objective With the popularity of medical prevention, an aging society, an-d the improvement of economy level, senile valvular diseases have beca-me the theme of modern heart valvular diseases. Most senile valvular dis-eases combined multiple organ failure, it costed the high risk in operation. The development of heart valvular surgery in our country’s has tended to be mature, but the pathology and physiology of senile valvular diseases progressed rapidly, even we adopted the perioperative managements, good myocardial protection, and improved cardiac surgery skills, it still held an high-level incidence of postoperative complications and mortality. The arti-cle compares the clinical data of senile heart valvular diseases whose age is greater than or equal to 60 years old with suffered from heart valvular diseases whose age under 60 years old, performs a clinical study, summa-rizes the surgical treatment of the senile heart valvular diseases and perio-perative managements, in order to reduce the incidence of complications and mortality of valvular replacement, enhance the quality of long-term li-fe.Method The clinical datas of 232 patients with heart valvular disease wh-o accepted the surgical treatment in the cardiac surgery of the first affilia- ted hospital of Guangxi Medical University from December 2013 to Febr-uary 2016 were retrospectively analyzed, aged 17 to 74 years old, the tw-o groups of people by age greater than or equal to 60 years into senile group (60-74 years old) 112 cases, less than 60 years old into the control group(17-59 years old) 120 cases. In the aspect of etiology,151 cases of rheumatic heart valvular disease, non rheumatic heart valvular disease (in-clude infective endocarditis, congenital heart disease, degeneration) in 81 cases. In terms of complications, atrial fibrillation in 54 cases, pulmonary hypertension in 141 cases, high blood pressure in 61 cases, coronary sten-osis in 20 cases. Total groups received of aortic valvular replacement (AV R) in 129 cases, mitral valvular replacement/mitral valvular repairment (M VR/MVP) in 147 cases, tricuspid valvular plasty/tricuspid valvular replace ment(TVP/TVR) in 113 cases. In the senile group, include preoperative c-ardiac function NYHA classification Ⅱ 28 cases,81 cases of level III and 3 cases of level IV, cardio thoracic ratio(CTR)0.74±0.12, left ventricular ejection fraction(LVEF)50%±10%. Using the biological disc in 40 cases, the mechanical valve in 72 cases, received double valves replacement in 15 cases, they received preoperative coronary angiography(CAG),12 cases coronary artery bypass grafting(CABG) during this period, left atrial foldi-ng in 67 cases, radiofrequency ablation in 6 cases, installing temporary p-acemaker godet in 48 cases. In the control group, include preoperative ca-rdiac function classification Ⅱ 25 cases,90 cases of level Ⅲ and 5 cases of level IV, CTR 0.72±0.08, LVEF 52%±9%. Using biological disc in 8 cases, mechanical valve in 112 cases, received lines of double valves rep-lacement in 27 cases, with aortic root expand repairment, repairment of a-trial septal defect, repairment of ventricular septal defect, received preope- rative CAG,4 cases CABG were in the same period,65 cases of left atr-ial folding, radiofrequency ablation 15 cases, installing temporary pacema-ker godet 41 cases. Postoperative routine to the intensive care unit, two groups of patients with early postoperative complication incidence, mortali-ty and cardiac function in patients with improvement.Result Early postoperative the senile group 4 cases died (account for 3. 6%), the control group for 1 case (account for 0.8%). The leading cause s of death mainly caused by low cardiac output syndrome, respiratory dysfu n-ction. The differences between two sets of application are biological val v-ulars ratio, operation scheme, the intensive care by tracheal time, intensi vecare time, total hospitalization time remained statistically significance (P <0.05). Some differences of preoperative CTR and LVEF, complications, a ort-ic cross-clamp time, turnaround time didn’t remained statistical significa nce(P>0.05). Postoperative 3 months of follow-up, the patients’CTR were narrowed, LVEF got higher, cardiac function was improved significantly.Conclusion It is an effective way for treating valvular diseases by doing heart valve replacement in senile valvular diseases, should pay attention to perioperative management, choose operation time after improving cardi-opulmonary function, stabling internal environment, strengthening myocard-ial protection, shorten the aorta blocking time, machine time, constantly i-mprove the operation skill, is critical to improve the success rate of oper-ation. When the senile patients with multiple organ dysfunction, we should strengthen the perioperative management.