| Background and Objective:Multi-valvular disease has always been clinically difficult and serious,and aortic valve with mitral valve disease is the most common.Double valve replacement has a high risk and poor prognosis,which is a hot and difficult point for cardiac surgeons at home and abroad to follow up.Among them,in patients with small diameter of aortic valve ring,it is still a challenge for surgeons to choose the type of artificial valve during aortic valve replacement.With the continuous improvement of the average life expectancy and the aggravation of the aging problem in our country,the proportion of middle-aged and elderly women in these patients has increased significantly,and the corresponding cases of multi-valvular disease with small aortic valve ring have an increasing trend year by year,and the surgical risk is also further increased.The goal of the operation is to replace the diseased valve with a non-narrow artificial valve,relieve the stenosis of the left ventricular outflow tract,reduce the transvalvular pressure difference of the aortic valve,make the hemodynamics return to normal,and the clinical symptoms of the patients can be solved.However,prosthetic valve replacement may lead to Prosthesis-Patient Mismatch(PPM).The purpose of this study was to analyze the early changes of hemodynamics and cardiac function of 19 mm St Jude Medical Regent(SJMR)mechanical valve during combined aortic and mitral valve replacement in elderly patients with small aortic annulus in our hospital,and to explore whether there is artificial valve-patient mismatch.The purpose of this study is to provide help for the selection of artificial valve types in clinical treatment in the future,and to provide a certain basis for preventing and reducing the incidence of PPM phenomenon.Methods:In this study,a retrospective study was used to count 54 patients who underwent aortic valve replacement and mitral valve replacement in the Department of Cardiac surgery of Shandong Provincial Hospital affiliated to Shandong University from December 2014 to November 2018.All the patients were small aortic annulus diameter(that is,the diameter of aortic valve annulus measured by valvular meter during operation was smaller than that of 23mm),and all patients were divided into two groups according to the specific type of aortic valve replacement during operation.19mm SJMR valve group:19mm St Jude Medical Regent valve was replaced in all aortic valve position in 30 cases.21mm conventional mechanical valve group:24 cases of 21mm conventional mechanical valve were replaced at the same time.The data were collected from the remote electronic medical record system of Shandong provincial hospital to collect basic information such as hospitalization number,sex,age,height,weight and previous medical history.At the same time,the operation time,cardiopulmonary bypass(CPB)time,aortic clamping time and days in intensive care unit were recorded in detail.The indexes of patients before admission,before operation,before discharge and echocardiography were collected by the ultrasonic diagnosis and treatment department of our hospital,and the postoperative follow-up data were collected by telephone follow-up and outpatient revisit to collect anticoagulation indexes,echocardiography and so on.SPSS Statistics 25.0 was used for data analysis.The results with statistical differences were analyzed by multiple linear regression analysis,and the multiple linear regression analysis equation was established,and the variables were selected by Stepwise method.Results:1.There was no cardiac event between the two groups during perioperative period and within 6 months after operation.there was no significant difference in left ventricular weight and weight index and aortic valve transvalvular pressure difference(PGav)between the two groups(P<0.05),LVM reduce,LVMI reduce(P>0.05).2.The left ventricular ejection fraction(LVEF)was significantly increased in the 19mm SJMR valve group(P=0.007).There was no significant increase in LVEF in 21 mm conventional mechanical valve group,and there was significant difference between the two groups(P<0.001).3.All the factors affecting the recovery of postoperative LVEF were analyzed by multiple linear regression,and the standardized multiple linear regression equation was obtained as follows:y=0.242X1-0.348X2-0.360X3-0.226X4.The postoperative LVEF,was divided into preoperative LVEF,aortic valve group(0:SJMR19 valve group,1:21mm routine valve group),preoperative left ventricular end-diastolic diameter and hospitalization days.Conclusions:1.For the elderly patients with no obvious obesity(BMI<28kg/m2)and small aortic valve diameter,good hemodynamic and clinical results can be obtained in the early stage of 19 mm St Jude Medical Regent valve replacement.the postoperative left ventricular ejection fraction was significantly better than that of 21 mm conventional mechanical valve group,and the other indexes reached the level of conventional mechanical valve replacement group,and there was no need for aortic root enlargement.2.Aortic root enlargement plus valve replacement is recommended for young and middle-aged patients.3.Preoperative improvement of left ventricular function and active education to patients to control body weight are effective means to avoid PPM. |
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