Surgical Treatment Of Valvular Heart Disease In Elderly

?Objective?We collected all the patiets' Clinical data who is more than 60 years old in a single centre to observe the changes from.Janaury 2001 to December 2014 And then we evaluate the Society of Thoracic Surgeons 2008and2013 risk tools in our country.At last,we want to find out the Risk Factors of Valve Surgery for the elderly.?Methods? 1.Valve surgery in elderly peoples from.Janaury 2001 to December 2014(1)The study population contains patients 60 years old or older who underwent valve surgery(single valve or multi valve or valve with CABG)between 2001 and 2014.(2)We separate this 14 years into two periods,so we can observe the changes with the time 2 Evaluation of the STS valve score model for elderly patients with valvular heart surgery:(1).according to the STS score models for isolated valve and for multi-valves,we retrospectively collected elderly patients' clinical information,including who went on coronary artery bypass graft(CABG)surgery at the same time,excluding aorta surgery,congenital heart disease and surgical treatment of atrial fibrillation patients.To define death during hospitalization as the end point.(2),by comparing the actual mortality and the predicted mortality.we can see the accuracy of the model and discuss the current model for heart valve surgery in elderly patients.3.Risk factors for In-hospital mortality associated with valve surgery in the elderly people 1.Select ?60 years old valve surgery patients as research subjects,including valve replacement,valve repair,coronary bypass surgery at the same time,excluding the aorta surgery,congenital heart disease.2.Collect clinical date before and during surgery 3.All variables significant in the univariate analysis were subsequently entered into a multiple regression analysis ?Results? 1.The changes In elderly patients with valvular disease.(1)Preoperative situation the proportion of elderly patients increased.Etiology of Heart Valve: rheumatic heart disease decreased,Degenerative valvular disease.690 Patients with hypertension accounted for 31.5%,370 cases with diabetes mellitus accounted for 16.9%,465 patients with coronary heart disease accounted for 21.2%,which are all showing a rising trend(2).Operative situation In the the cardiopulmonary bypass surgery,the mean CPB time is 103.7 ± 39.7 minutes and aortic cross-clamp time is 62.5 ± 29.3 minutes.With the rise in surgical proficiency and stability,cardiopulmonary bypass and aortic clamping time has declined with tue time going.382 cases with multi valve replacement surgery(MVR + AVR)accounted for 17.4%,681 aortic valve replacement(AVR)accounted for 31.1%,708 mitral valve replacement(MVR)accounted for 32.3%,331 mitral valvuloplasty(MVP)accounted for 15.1%;376 cases of coronary artery bypass surgery was made with valve surgery accountting for 17.2%.Accumulated prosthetic heart valves is 2155,722 biosystems valve was used accounted for 33.5%,1433 mechanical valves was used accounted for 66.5%,the proportion of biological valve in recent years has increased.109 cases of surgery patients were dead in hospital death with rate 4.98%,the main reasons cause of death include respiratory insufficiency,heart failure with multiple organ failure,acute renal failure,and cerebrovascular complications(embolism and bleeding).2. Evaluation of the STS valve scoring model for elderly patients in our country(1).The whole group of 2483 cases of actual patients in hospital mortality rate was 4.79%,STS risk scoring model predicted postoperative mortality was3.74%,the actual mortality / mortality prediction was 1.28.P>0.05.STS valve risk models does good(2) To identify the discrimination validity of this model with the size of the area under the ROC curve.Statistics show that the area under the ROC curve was 0.635,less than 0.7,suggesting that STS valve score models' discrimination validity is not ideal,can't accurately predict the patients' mortality in china3. Risk factors of operative mortality in the elderly patients with valvular surgery: 1.The whole group of 2483 patients in the hospital with 119 patients died,the mortality rate was 4.79%.The main causes of death include severe infection,multiple organ organ failure,.low cardiac output syndrome,a fatal arrhythmia.2.Statistical Univariate analysis showed: aged,associated with coronary heart disease,chronic lung disease,preoperative creatinine,poor cardiac function,preoperative critical condition,coronary artery bypass graft at the same timme,long time of CPB and Aortic cross-clamping and risk factors in elderly patients with valvular surgery in hospital mortality.Logistics regression analysis showed that age,chronic lung disease,cardiac function is poor,long time of CPB are the independent risk factors for valve surgery in elderly patients perioperative mortality.?Conclusions? 1.Although valve disease in the elderly is increasing,The proportion of rheumatic heart disease is falling,but it is still the main cause of valve disease;degenerative valvular disease increased year by year,we need to pay attention 2.STS valve model for risk assessment of valve disease in elderly perioperative mortality is not accurate enough,in the future we need more accurate risk model for each sub-population.3.aged,chronic lung disease,cardiac function is poor,long time of CPB are the independent risk factors for valve surgery in elderly patients perioperative mortality.