Clinical Analysis Of 128 Cases In Reoperation With Prosthetic Valve Replacement

Objective:Through to collect the case in reoperation with prosthetic valve replacement,analyze the cause of heart valve replacement again,the key points of diagnosis and treatment of preoperative,perioperative,selection of valves and postoperative outcomes,complications.Sum up the experiences of treatment and provide reference for future similar cases.Methods: Selected from January 2000 to December 2015 visits Fujian Province Hospital cardiovascular division 128 patients who underwent heart valve replacement in hospitalized patients again as the research object,including 50 cases of male(39.1%),78 cases of female(60.9%),aged 21 to 70(45.6 + 11.4),by collecting and recording in patients with preoperative general information,and for the first time interval,preoperative complications,heart function,cardiothoracic ratio,reoperation methods,postoperative complications of clinical data,using SPSS23.0 software for statistical analysis.Results: In all 128 patients,reperation with valve replacement can be divided into two categories,the cause of category is ectopic valve disease continue to progress,a total of 64(50%)cases,including rheumatoid disease by mitral valve extended to 30(23.4%)cases of aortic valve and tricuspid valve secondary lesions in 34(26.6%)cases.In the other group,there were 64(50%)cases of artificial valve obstruction and complications in situ,including biological valve failure 22(17.2%)and mechanical valve related complications 42(32.8%).Early postoperative complications including pulmonary infection 28 cases(21.9%)and low cardiac output syndrome(LCOS)10 cases(7.81%),massive hemorrhage in 10 cases(7.81%),massive pleural effusion,10 cases(7.81%),ventricular fibrillation,8 cases(6.25%),multiple organ dysfunction syndrome(MODS),8 cases(6.25%),6 cases of acute left heart failure(4.69%),etc.18 cases died after operation,of which 12 cases were related to mechanical discs causes complications patients,3 cases of rheumatic lesion by mitral valve extensions to aortic valve disease patients,3 cases of tricuspid etiology in patients with secondary pathological changes,no biological disc decline cause death of patients,the hospital mortality was 14.1%.The causes of death were LCOS,MODS,acute left ventricular failure,etc.The indexes of 1 week after surgery(NYHA),left atrial diameter(LAD),left ventricular diastolic internal diameter(LVEDD)and left ventricular ejection fraction(LVEF)were significantly improved.Conclusion: 1.Rheumatoid disease by mitral valve extensions to the aortic valve and tricuspid valve secondary lesion,biological disc decline,mechanical valve related complications are this group of patients in the most common cause of valve surgery again.2.Because once again surgery patients with long duration and severe valvular disease progress,patients with extracorporeal circulation again to hit the big,postoperative risk big,the case fatality rate is high,especially in the patients with mechanical valve related complications cause.3.According to this study,with the improvement of surgical technique and extracorporeal circulation technology,the postoperative mortality rate of patients with reoperation is decreasing gradually,which is safe and feasible.