Objective To summarize safety and effectiveness of cryomaze ablation procedure concomitant with valve surgery. Methods We retrospectively investigated the clinical data of 62 patients (24 males and 38 females) with mean age of 49.4±14.2 years who underwent cryomaze ablation procedure concomitant with valve surgery in our hospital from August 2013 through July 2015. The heart rhythm of the patients after surgery was supervised by 12-leads electrical cardiogram respectively. Results The rate of sinus rhythm restored right after surgery was 98.4%. The rate of sinus rhythm restored at the time of discharge was 93.4%. The rate of sinus rhythm restored 3 months, 6 months, 12 months, 18 months after surgery was 90.2%, 87.3%, 85.0%, 83.3% respectively. The one-year post-operation rate of sinus rhythm restored for the group of right minimal invasive thoracoscopic assisted mitral valve surgery was 90.5%. Longer duration for atrial fibrillation (>7 years) was a risk factor for the reoccurrence of atrial fibrillation 1 year after surgery (P<0.05). Conclusion Cryomaze ablation procedure concomitant with valve surgery is quite effective in treatment of rheumatic valve disease and atrial fibrillation. This approach is associated with fewer complications, comparable atrial fibrillation reoccurrence for short-term follow-up.
Objective To summarize the outcomes and clinical features for surgical treatment of nonischemic heart valve disease(HVD) combined with coronary artery disease(CAD), so that to get better surgical result. Methods From January 2000 to June 2007, 105 patients with the mean age of 61.96±7.61 years (range 36-79 years), underwent the combined procedures.The etiology of HVD included: 59 rheumatic valve disease, 24 degenerative mitral lesion, 13 calcified aortic valve lesion, and 9 other aortic valve disease. CAD was preoperatively diagnosed by coronary arteriongraphy in 98 patients, and intraoperatively identified in 7 patients. Left ventricular ejection fraction was 50% or less in 45 patients. The total number of bypass grafts was 216 with the mean of 2.06 grafts per patient. Valve procedures included: 36 mitral valve valve replacement, 15 mitral repair,43 aortic valve replacement, 11 mitral valve and aortic valve replacement. Results There were 6 postoperative deaths with the mortality of 5.7%. The causes of death were 3 low cardiac output syndrome, 2 renal failure, and 1 heart arrest resulting in multiple organs failure. Ninety-three survivals were followed up from 1 month to 7 years, 6 patients were missed on follow-up. There were no late death. New York Heart Association class Ⅰ was observed in 25 patients, class Ⅱ53, class Ⅲ 10 and class Ⅳ 5. One patient still had existential chest pain. Conclusion There were no typical angina in majority of patients with nonischemic HVD combined with CAD, coronary arteriongraphy must be taken in patients with the age of 50 years and more, or with the risk factors for CAD.Intraoperative myocardial protection is very important because CAD further deteriorates myocardial dysfunction caused by HVD.The decreased left ventricular function is the important factor affecting the surgical results and it is hard to evaluate the underlying cause before the operation.
ObjectiveTo assess the accuracy of European System for Cardiac Operative Risk Evaluation (EuroSCORE) model in predicting the in-hospital mortality of Uyghur patients and Han nationality patients undergoing heart valve surgery. MethodsClinical data of 361 consecutive patients who underwent heart valve surgery at our center from September 2012 to December 2013 were collected, including 209 Uyghur patients and 152 Han nationality patients. According to the score for additive and logistic EuroSCORE models, the patients were divided into 3 subgroups including a low risk subgroup, a moderate risk subgroup, and a high risk subgroup. The actual and predicted mortality of each risk subgroup were studied and compared. Calibration of the EuroSCORE model was assessed by the test of goodness of fit, discrimination was tested by calculating the area under the receiver operating characteristic (ROC) curve. ResultsThe actual mortality was 8.03% for overall patients, 6.70% for Uyghur patients,and 9.87% for Han nationality patients. The predicted mortality by additive EuroSCORE and logistic EuroSCORE for Uyghur patients were 4.03% and 3.37%,for Han nationality patients were 4.43% and 3.77%, significantly lower than actual mortality (P<0.01). The area under the ROC curve of additive EuroSCORE and logistic EuroSCORE for overall patients were 0.606 and 0.598, for Han nationality patients were 0.574 and 0.553,and for Uyghur patients were 0.609 and 0.610. ConclusionThe additive and logistic EuroSCORE are unable to predict the in-hospital mortality accurately for Uyghur and Han nationality patients undergoing heart valve surgery. Clinical use of these model should be considered cautiously.
Abstract： Objective To establish a risk prediction model and risk score for inhospital mortality in heart valve surgery patients, in order to promote its perioperative safety. Methods We collected records of 4 032 consecutive patients who underwent aortic valve replacement, mitral valve repair, mitral valve replacement, or aortic and mitral combination procedure in Changhai hospital from January 1,1998 to December 31,2008. Their average age was 45.90±13.60 years and included 1 876 (46.53%) males and 2 156 (53.57%) females. Based on the valve operated on, we divided the patients into three groups including mitral valve surgery group (n=1 910), aortic valve surgery group (n=724), and mitral plus aortic valve surgery group (n=1 398). The population was divided a 60% development sample (n=2 418) and a 40% validation sample (n=1 614). We identified potential risk factors, conducted univariate analysis and multifactor logistic regression to determine the independent risk factors and set up a risk model. The calibration and discrimination of the model were assessed by the HosmerLemeshow (H-L) test and [CM(159mm]the area under the receiver operating characteristic (ROC) curve,respectively. We finally produced a risk score according to the coefficient β and rank of variables in the logistic regression model. Results The general inhospital mortality of the whole group was 4.74% (191/4 032). The results of multifactor logistic regression analysis showed that eight variables including tricuspid valve incompetence with OR=1.33 and 95%CI 1.071 to 1.648, arotic valve stenosis with OR=1.34 and 95%CI 1.082 to 1.659, chronic lung disease with OR=2.11 and 95%CI 1.292 to 3.455, left ventricular ejection fraction with OR=1.55 and 95%CI 1.081 to 2.234, critical preoperative status with OR=2.69 and 95%CI 1.499 to 4.821, NYHA ⅢⅣ (New York Heart Association) with OR=2.75 and 95%CI 1.343 to 5641, concomitant coronary artery bypass graft surgery (CABG) with OR=3.02 and 95%CI 1.405 to 6.483, and serum creatinine just before surgery with OR=4.16 and 95%CI 1.979 to 8.766 were independently correlated with inhospital mortality. Our risk model showed good calibration and discriminative power for all the groups. P values of H-L test were all higher than 0.05 (development sample: χ2=1.615, P=0.830, validation sample: χ2=2.218, P=0.200, mitral valve surgery sample: χ2=5.175,P=0.470, aortic valve surgery sample: χ2=12.708, P=0.090, mitral plus aortic valve surgery sample: χ2=3.875, P=0.380), and the areas under the ROC curve were all larger than 0.70 (development sample: 0.757 with 95%CI 0.712 to 0.802, validation sample: 0.754 and 95%CI 0.701 to 0806; mitral valve surgery sample: 0.760 and 95%CI 0.706 to 0.813, aortic valve surgery sample: 0.803 and 95%CI 0.738 to 0.868, mitral plus aortic valve surgery sample: 0.727 and 95%CI 0.668 to 0.785). The risk score was successfully established: tricuspid valve regurgitation (mild:1 point, moderate: 2 points, severe:3 points), arotic valve stenosis (mild: 1 point, moderate: 2 points, severe: 3 points), chronic lung disease (3 points), left ventricular ejection fraction (40% to 50%: 2 points, 30% to 40%: 4 points, ＜30%: 6 points), critical preoperative status (3 points), NYHA IIIIV (4 points), concomitant CABG (4 points), and serum creatinine (＞110 μmol/L: 5 points).Conclusion Eight risk factors including tricuspid valve regurgitation are independent risk factors associated with inhospital mortality of heart valve surgery patients in China. The established risk model and risk score have good calibration and discrimination in predicting inhospital mortality of heart valve surgery patients.
Objective To analyze risk factors for prolonged stay in intensive care unit (ICU) after cardiac valvular surgery. Methods Between January 2005 and May 2005, five hundred and seven consecutive patients undergone cardiac valvular surgery were divided into two groups based on if their length of ICU stay more than 5 days (prolonged stay in ICU was defined as 5 days or more). Group Ⅰ: 75 patients required prolonged ICU stay. Group Ⅱ: 432 patients did not require prolonged ICU stay. Univariate and multivariate analysis (logistic regression) were used to identify the risk factors. Results Seventyfive patients required prolonged ICU stay. Univariate risk factors showed that age, the proportion of previous heart surgery, smoking history and repeat cardiopulmonary bypass (CPB) support, cardiothoracicratio, the CPB time and aortic crossclamping time of group Ⅰ were higher or longer than those of group Ⅱ. The heart function, left ventricular ejection fraction (LVEF), pulmonary function of group Ⅰwere worse than those of group Ⅱ(Plt;0.05, 0.01). Logistic regression identified that preoperative age≥65 years (OR=4.399), LVEF≤0.50(OR=2.788),cardiothoracic ratio≥0.68(OR=2.411), maximal voluntary ventilation observed value/predicted value %lt;71%(OR=4.872), previous heart surgery (OR=3.241) and repeat CPB support during surgery (OR=18.656) were final risk factors for prolonged ICU stay. Conclusion Prolonged ICU stay after cardiac valvular surgery can be predicted through age, LVEF, cardiothoracic ratio, maximal voluntary ventilation, previous heart surgery and repeat CPB support during surgery. The patients with these risk factors need more preoperative care and postoperative care to reduce mortality, morbidity and avoid prolonged ICU stay after cardiac valvular surgery.
ObjectiveTo evaluate the effect of driving pressure-guided lung protective ventilation strategy on lung function in adult patients under elective cardiac surgery with cardiopulmonary bypass.MethodsIn this randomized controlled trial, 106 patients scheduled for elective valve surgery via median sternal incision under cardiopulmonary bypass from July to October 2020 at West China Hospital of Sichuan University were included in final analysis. Patients were divided into two groups randomly. Both groups received volume-controlled ventilation. A protective ventilation group (a control group, n=53) underwent traditional lung protective ventilation strategy with positive end-expiratory pressure (PEEP) of 5 cm H2O and received conventional protective ventilation with tidal volume of 7 mL/kg of predicted body weight and PEEP of 5 cm H2O, and recruitment maneuver. An individualized PEEP group (a driving pressure group, n=53) received the same tidal volume and recruitment, but with individualized PEEP which produced the lowest driving pressure. The primary outcome was oxygen index (OI) after ICU admission in 30 minutes, and the secondary outcomes were the incidence of OI below 300 mm Hg, the severity of OI descending scale (the Berlin definition), the incidence of pulmonary complications at 7 days after surgery and surgeons’ satisfaction on ventilation.ResultsThere was a statistical difference in OI after ICU admission in 30 minutes between the two groups (273.5±75.5 mm Hg vs. 358.0±65.3 mm Hg, P=0.00). The driving pressure group had lower incidence of postoperative OI<300 mm Hg (16.9% vs. 49.0%, OR=0.21, 95%CI 0.08-0.52, P=0.00) and less severity of OI classification than the control group (P=0.00). The incidence of pulmonary complications at 7 days after surgery was comparable between the driving pressure group and the control group (28.3% vs. 33.9%, OR=0.76, 95%CI 0.33-1.75, P=0.48). The atelectasis rate was lower in the driving pressure group (1.0% vs. 15.0%, OR=0.10, 95%CI 0.01-0.89, P=0.01).ConclusionApplication of driving pressure-guided ventilation is associated with a higher OI and less lung injury after ICU admission compared with the conventional protective ventilation in patients having valve surgery.
ObjectiveTo analyze factors affecting the recovery of postoperative left ventricular function in patients with valvular disease combined with heart failure with reduced ejection fraction [HFrEF, left ventricular ejection fraction (LVEF)<40%].MethodsThe clinical data of 98 patients with valvular disease combined with HFrEF who underwent surgeries in our hospital from January 2011 to June 2018 were retrospectively analyzed, including 75 males and 23 females aged 9-78 (55.3±11.9) years.ResultsA total of 15 patients were dead after the operation, including 4 deaths within 3 months and 11 mid-long-term deaths after the operation. Ninety-one patients were followed up for more than 6 months (10 months to 8.6 years). The postoperative cardiac function (NYHA) of 91 patients was classⅠ-Ⅱ, the LVEF of 18 (19.8%) patients increased more than 10%, that of 47 (51.6%) patients maintained at the preoperative level, and that of 26 (28.6%) patients decreased. Postoperative LVEF was more prone to recover in HFrEF patients with sinus rhythm before operation (P=0.038), valvular disease mainly in aortic valve (P=0.026), obvious reduction of left ventricular end diastolic diameter in early postoperative period (P=0.017), and higher systolic pulmonary artery pressure (SPAP) before operation (P=0.018). The risk factors for postoperative LVEF deterioration included large left atrium before operation (P=0.014), smaller left ventricle end systolic diameter before operation (P=0.003), and fast heart rate after operation (P=0.019). ConclusionMitral valve prolapse patients with obviously increased left ventricular diameter should receive operation as soon as possible. HFrEF patients with aortic valve disease should receive operation positively. The operation efficacy is satisfactory in the HFrEF patients with high SPAP.