Analysis Of Related Risk Factors Of Perioperative Complications For 720 Cases Of Valve Replacement

[Purpose] Valvular heart disease is still a burden to the clinical and public health.Rheumatic fever has yet been the main cause leading to valvular disease among developing countries. The incidence rate of adult rheumatic valvular heart disease is between 2.34‰ to 2.72‰ in China. The treatment for valvular heart disease includes medical and surgical management. However, surgical treatment is considered as the only method that can effectively improve patients'condition and prognosis for thosewho have valvular heart disease. Prosthetic mechanical valve replacement is the main surgical approach chosen to treat valvular heart disease in Yunnan province. Although cardiac surgery with the support of extracorporeal circulation has been a mature treatment for heart disease after approximately half century development, it is still undoubtedly a very complicated and special procedure. This study has collected the data from the patients who underwent prosthetic mechanical valve replacement in the cardiovascular surgery department, including their preoperative, intraoperative information and perioperative complications. It aims to provide clinical reference for reducing and preventing the perioperative complications of valve replacement in Yunnan province by analyzing the related risk factors causing those complications and implementing preventive measures.[Method] Based on the inclusion criteria from both domestic and foreign literature as well as related risk models, this study has selected 720 patients who underwent prosthetic mechanical valve replacement at the cardiovascular surgery department of Kunming Yan'an Hospital during Jan 1 2011 and March 1 2013. The inclusive potential risk factors consist of age, gender, course of disease, atrial fibrillation,cardiac function grading, history of hypertension and diabetes, liver and renal function, ejection fraction (EF), left ventricular end-diastolic volume (LVEDV), left atrial end-diastolic volume (LAEDV), choice of operation, type of disease, bypass time and aortic clamp time. The perioperative complications include low cardiac output syndrome, ventricular fibrillation, cardiac arrhythmia, renal failure, liver failure, multiple organ dysfunction syndrome (MODS), stroke, hypoxia, cardiac arrest,unstable blood circulation, cardiac tamponade, pericardial effusion and pulmonary inflammatory exudation. The study adopted variance analysis and chi-square test to get the related potential risk factors. It used Logistic univariate and multivariate regression model and then tried to find out the relation between the potential risk factors and related complications by using SPSS 22.[Result] There were 220 patients had complications among the 720 selected cases,including 31 cases of low cardiac output syndrome (10.8%), 2 cases od ventricular fibrillation (0.7%), 47 cases of cardiac arrhythmia (16.7%), 7 cases of acute renal failure (2.4%), 2 cases of liver failure (0.7%), 5 cases of MODS (1.7%), 6 cases of stroke (2.1%), 4 cases of hypoxia (1.4%), 2 cases of cardiac arrest (0.7%), 15 cases of unstable blood circulation (5.2%), 2 cases of cardiac tamponade, 75 cases of pericardial effusion (26.1%), 14 cases of pleural effusion (4.9%), 1 case of perivalvular leakage (0.3%), 74 cases of pulmonary inflammatory exudation (25.8%)and 6 cases of death.Logistic univariate analysis results are as following:age, gender, history of diabetes, preoperative atrial fibrillation, rheumatic valvular heart disease, degenerative mitral valve disease, choice of operation are respectively the independent risk factors of perioperative cardiac arrest, acute renal failure,unstable blood circulation, arrhythmia, hypoxia and ventricular fibrillation (p<0,05?;long course of disease is the independent risk factor of perioperative hypoxia,renal failure and pleural effusion (p<0.05 = ; infective pericarditis is the independent risk factor of perioperative MODS, impaired liver function and renal failure (p<0.05?;LVEDV is the independent risk factor of perioperative low cardiac output syndrome, MODS and arrhythmia (p<0.05 = ; LAEDV is the independent risk factor of renal failure,unstable blood circulation and pericardial effusion (> 10mm) (p<0.05 =; bypass time is the independent risk factor of perioperative low cardiac output syndrome, renal failure, unstable blood circulation, cardiac tamponade and pericardial effusion (p<0.05 =; aortic clamp time is the independent risk factor of perioperative low cardiac output syndrome, unstable blood circulation, pericardial effusion, pleural effusion and cardiac tamponade (p<0.05 =; Logistic multivariate regression model analysis showed that preoperative EF, LVEDV, bypass time and aortic clamp time are the risk factors leading to perioperative low cardiac output syndrome (p < 0.05 ?;gender, course of disease, creatinine level, LAEDV, bypass time and aortic clamp time are the risk factors leading to perioperative acute renal failure ) (p < 0.05 =;preoperative creatinine level, LVEDV, aortic valve replacement are the risk factors leading to perioperative MODS (p<0.05 =; bypass time and aortic clamp time are the risk factors leading to perioperative stroke (p < 0.05 =; preoperative history of diabetes, LAEDV, bypass time and aortic clamp time are the risk factors leading to perioperative unstable blood circulation (p<0.05=.[Conclusion] This study has found that the effect of valvular surgery is closely related to many factors such as patients' medical history, main organs function status,pathological changes of the heart, choice of operation, cardiopulmonary bypass time and perioperative intervention. The occurrence of perioperative complications is a complicated pathophysiological process. Careful selection of patients and safe procedure with effective intraoperative and postoperative interventions are the approaches that can effectively reduce the incidence of complications for the patients who underwent valve replacement.