Clinical Analysis Of Aortic Valve Replacement And Concomitant Coronary Artery Bypass Graft Surgery

Objective: To assess short-term effect of aortic valve replacement combined with coronary artery bypass graft,To analyze the related factors affecting the early prognosis of aortic valve replacement combined with coronary artery bypass graft, To summarize the proper diagnostic and therapeutic procedure of disease, improve the treatment effect, and provide reference for clinical.Methods: From January 1, 2007 to December 31, 2015, 36 patients with aortic valve replacement and coronary artery bypass grafting were reviewed, including 24 males and 12 females, mean age(61.31 + 15.68) years old, Among them, 3 patients with congenital aortic valve disease, 16 cases of rheumatic aortic valve disease, 12 cases of degenerative aortic valve disease, 2 cases of infective endocarditis involving aortic valve, Aortic valve reoperation in 3 cases.All the groups were operated under general anesthesia cardiopulmonary bypass surgery, cardiopulmonary bypass time was 72-382(167±75)min,aortic occlusion time 30-278(100±49) min, Biological valve replacement in 10 cases, mechanical valve replacement in 26 cases,The average number of vascular grafted was 1.44.The operation steps were generally first procedure coronary artery distal anastomosis, then operated aortic valve replacement,In the end, the anastomosis of the proximal vessels was performed and the routine monitoring was given, and the corresponding treatment measures were given according to the patient's condition.Comparison of preoperative and postoperative early echocardiographic parameters including diameter of left atrium(LA), left ventricular end diastolic diameter(LVEDd), left ventricular end systolic diameter LVEDs, left ventricular posterior wall thickness(LVPW), interventricular septum thickness(IVS), left ventricular shoot ejection fraction(LVEF),aortic transvalvular pressure and NYHA classification.The mortality rate and the incidence of severe complications were analyzed, and the related factors influencing the prognosis of the patients were analyzed.Results:Five patients died during hospitalization,7 patients with severe complications,All of the other patients were recovered.After surgery,the patient's clinical symptoms relieved remarkably,cardiac function classification(NYHA)compared with the preoperative significantly improved.Comparison of preoperative and postoperative echocardiography index shows: LA,LVED and LVES compared to preoperative decreased significantly(P<0.01), postoperative aortic transvalvular pressure was decreased significantly(P<0.01), IVS and LVPW, LVEF showed no significant difference(P>0.05).The perioperative mortality was 13.9%, and the incidence of severe complication was 19.4%.The causes of death were low cardiac output syndrome(LCOS) and multiple organ failure syndrome(MODS).The results showed age greater than or equal to 60 years old,female,aortic valve transvalvular gradient is related factors affecting the prognosis, showed statistical difference(P<0.05).Conclusion:1.Aortic valve replacement combined with coronary artery bypass graft is an effective method for the treatment of aortic valve disease.2.Pay attention to the risk factors of cardiovascular diseases such as age, gender.Careful evaluation the functional status of organ system in elderly patients before operation, After the disease is relatively controlled and then procedure surgery,strengthening myocardial protection during operation, shorten operation time, reduce the temperature and ischemia reperfusion injury,postoperative intensive care, rational use of vasoactive drugs, timely treatment of complications, so as to improve the curative effect of the prognosis of.3.The recent curative effect of aortic replacement with coronary artery bypass graft is remarkable, but the long-term effect needs further study.