Surgical Treatment Of Patients With Severe Valvular Disease

OBJECTIVE: To explore the experience of perioperative management of patients with severe valvular disease,to evaluate the effect of postoperative and short-term and long-term death factors,to summarize the experience of treatment of severe valvular disease,to reduce the postoperative complications,shorten the hospitalization time and improve the patients' quality of life.METHODS: We selected the clinical data of 329 patients with heart valve replacement from January 2012 to June 2016 at the First Affiliated Hospital of Bengbu Medical College.The clinical data of 87 patients with severe valvular disease were retrospectively Analysis and follow-up observation.RESULTS: 1.Clinical features: The group of 87 patients,41 males and 46 females,aged 40 to 75 years,mean(51 ± 12.45)years of age,hospital days 27 to 58 days,the average hospital(32 ± 10.71)days.There were 65 cases(74.7%)of rheumatic valvular heart disease,12 cases(13.7%)of ischemic heart valve disease,4 cases(4.7%)of Marfan syndrome,2 cases of degenerative valvular heart disease(2.3%),2cases(2.3%)of secondary surgery of valve disease,2 cases of bacterial endocarditis(2.3%).There were 28 cases(32.1%)of simple mitral valvular disease,21 cases(24.1%)of simple aortic valve disease,16 cases(18.3%)with double valve disease,11 cases(12.6%)of valvular heart disease,There were 1 case(1.15%)of secondary tricuspid regurgitation and 4 cases(4.5%)of portal vein dilatation.Clinical manifestations: 58 cases of heart palpitations(66.7%),chest tightness,wheezing in 75cases(86.2%),chest tightness,chest pain in 10 cases(11.4%),sitting breathing,breathing difficulties in 40 cases(45.9%),34.4%),heart function classification(NYHA)? ~ ? grade 58 cases(66.7%).2.Surgical approach: 28 cases of mitral valve replacement(MVR),21 cases of aortic valve replacement(AVR),18 cases of aortic valve and mitral valve replacement(DVR),MVR plus coronary artery bypass grafting(CABG)7 cases,AVR plus CABG4 cases,Bentall surgery in 2 cases,Wheat surgery in 2 cases.At the same time,57 cases of tricuspid valvuloplasty were performed,35 cases of Kay angioplasty and 22 cases of Devega surgery.One patient underwent Carpentier ring fixation(TVP)with a large number of tricuspid regurgitation due to the absence of the recess.Intraoperative? degree atrioventricular block implantation of permanent cardiac pacemaker in 1case,due to low cardiac output temporary pacemaker installed in 31 cases.3.Postoperative comprehensive evaluation: 40 cases(45.9%)of postoperative complications were significantly higher in patients with severe valvular disease.The incidence of complications was higher than that of patients with non-severe valvular disease(18.9%),and postoperative low cardiac output 10 cases of pulmonary infection,21 cases of ventricular arrhythmia,3 cases of ventricular arrhythmia,liver and kidney dysfunction in 3 cases,2 cases of secondary thoracic hemostasis,1 case of multiple organ failure and so on.There were 10 cases(11.4%)of the patients after the operation,and the mortality rate was higher than that of the patients with non-severe valvular disease(1.65%)(P <0.05).Causes of death: postoperative low cardiac output syndrome,renal failure,ventricular fibrillation,left atrial rupture,left ventricular rupture,pulmonary infection.Preoperative echocardiography LAD 52.15 ± 13.84 mm,LVEDD 70.64 ± 6.73 mm,LVESD 52.73 ± 3.12 mm,postoperative review of echocardiography LAD 52.15 ± 13.84 mm,LVEDD 70.64 ± 6.73 mm,LVESD 42.15 ±9.91 mm,LVEDD 59.12 ±(NYHA)increased from 3.08 ± 0.85 to 2.73 ± 0.59 after operation.The cardiac function(NYHA)increased from 3.08 ± 0.85 to 2.73 ± 0.59 after operation.The results showed that NYHA had a significant difference between the two groups(P <0.001)Blood fraction EF was improved from preoperative(44.39% ± 3.41%)to postoperative(49.05% ± 10.76%).4.Long-term follow-up: Long-term follow-up 68 cases,tracking time 3 to 48 months,follow-up rate of 88.3%.One died of acute left heart failure and one died of acute coronary infarction.66 patients can basically maintain life,heart function class I 46,? 14,? 5,cardiac function ? level 1 person.The heart function(NYHA)2.01 ±0.32 was improved by 2.73 ± 0.59 and the ejection fraction EF(54.92% ± 6.89%)was improved after operation(49.05% ± 10.76%),all of which were statistically significant(P <0.05).Apoptosis and embolism associated with anticoagulationAccording to the monitoring PT values were divided into two groups: observation group,PT value range of 18-24 seconds;control group,PT value of less than 18 seconds or more than 24 seconds,the statistical results and statistical analysis The results in Table 14: observation group of 56 cases,1 case of bleeding;control group of12 cases,4 cases of bleeding,chi-square test results show that: observation group of patients with anticoagulation-related bleeding complications were significantly lower than the control group,P < 0.05,there were statistical differences;Conclusion: Patients with severe valvular disease have a high risk of surgery,and perioperative complications and mortality are more severe than non-severe valvular disease.Surgical treatment of patients with long-term quality of life improved significantly;Cardiac function of patients with severe valvular heart disease after surgery improved to a certain extent,,but not completely relieved;NYHA Cardiac function classification class IV,EF 40% is an independent risk factor for postoperative death in patients with severe valvular disease.Preoperative cardiac function adjustment in the treatment is essential.