The Safety And Effect Of Eldly Patients With Degenerative Mitral Regurgitation And Long-standing Atrial Fibrillation And Being Underwent Mitral Valve Surgery Combined With Maze Operation

Objective: To study the safety and effect of mitral valve surgery and maze procedure when being underwent in patients with senile degenerative mitral regurgitation and long-standing atrial fibrillation.Methods: A retrospective analysis from January 2012 to December 2015,in the Department of Cardiovascular Surgery of the General Hospital of Shenyang Military clearly diagnosed degenerative mitral regurgitation with long-standing atrial fibrillation,and being underwent mitral valve surgery and maze procedure.A total of 45 cases,all patients are divided into two groups,the elderly group(?60 years)with 21 cases,female7 cases,male 14 cases,the average age 64.67 ± 3.851 years old.The middle age group(< 60 years)has 24 cases,female 6 cases,male 18 cases,the average age 52.71 ± 4.982 years old.By comparing the operating related data between the two groups(operation time,Cardiopulmonary bypass(CPB)time,aortic clamping time,intraoperative blood loss),the postoperative recovery situation(the first 24 hours' drainage volume,the recovery time of anesthesia,postoperative ventilating time,postoperative intensive care unit(ICU)time,cardiac function of postoperative,postoperative complications),postoperative echocardiography(left atrial size,left ventricular size,left ventricular ejection fraction),mortality,postoperative hospitalization time,etc.By comparative the differences of liver function,renal function and hemoglobin,about the preoperative and before discharge from the hospital safety in each group to assessment of the safety of elderly patients being underwent mitral valve surgery and maze procedure.By the comparison of each group in preoperative and postoperative indexes(New York Heart Association(NYHA)classification,left atrium size,ventricular size,left ventricular ejection fraction,mitral regurgitation,etc.),to evaluate the effect of operation being performed mitral valve repair or replacement.By comparison the differences of cardioversion of atrial fibrillation between the elderly group and middle-aged group patients when discharged,to assessment of the effect of senile degenerative mitral regurgitation with long-standing atrial fibrillation after the maze procedure.Results: Two groups without postoperative cerebral infarction,no low cardiac output syndrome,no thoracotomy for hemostasis,no death.Operation related information: the operation time of elderly group,aortic clamping time,CPB time and hemoglobin urine during operation compared with the middle-age group,the differences are not statistically significant(P>0.05).Compared the blood using proportion of the elderly group with the middle-age group(47.62% in vs 16.67%,P = 0.025),the difference is statistically significant.And the recovery time of postoperative anesthesia,the first24-hours drainage volume,ventilation support time,ICU time,the use of anti arrhythmic drugs after surgery,postoperative cardioversion and the postoperative hospitalization days,compared with the middle-aged group(P>0.05),the difference are not statistically significant.By compared the indexes between the preoperative and the postoperative in each group: the middle-age group of the ALB,HB,CREA before discharge are decreased,the differences were statistically significant(P < 0.05),while the preoperative BU,TBIL,AST,and ALT compared with postoperative(P>0.05),the difference are not statistically significant.The elderly group of the ALB,HB,CREA,BU,TBIL.ALT when discharge compared with the preoperative,the difference was statistically significant(P<0.05).While the AST showed no significant difference(P>0.05).The cardiac function was significantly improved compared with preoperative in the two groups,the differences were statistically significant(P<0.001).Postoperative left atrial diameter,Left ventricular end diastolic diameter,left ventricular end systolic diameter,pulmonary artery systolic pressure decreased significantly compared with the preoperative,and the differences were statistically significant(P<0.001).The cardioversion success rate of the elderly group before discharge was lower than the middle-age group(43% vs 79%,p=0.012),and the difference was statistically significant.Conclusion: The eldly patients,with degenerative mitral regurgitation combined with long-standing atrial fibrillation and being underwent mitral valve surgery and maze procedure,are safety,and the postoperative cardiac function recover well.During early postoperative period,the rate of sinus rhythm maintaining is lower than middle-aged patients'.