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ObjectiveStudy the effects of mitral valve replacement using video-assisted thorascoscopy compared with median sternotomy mitral valve replacement.MethodsBetween October 2003 and October 2011,72 cases suffer from mitral valve disease underwent video-assisted thorascoscopic mitral valve replacement,74 cases underwent median sternotomy procedure.CPB time,cross clamp time,ventilation time,drainage,ICU stay time and hospital stay time of the two groups were compared.Results It was longer that CPB time and cross clamp time in video-assisted thoracospic group than those of median sternotomy group.There was statistically significant difference.However there was no statistically significant differentce in ventilation time and ICU stay time between two groups.Drainage of video-assisted thoracospic group was less than median sternotomy group.And there was statistically significant difference.ConclusionAs long as strictly a good indication,mitral valve surgery can routinely be performed with video-assisted thoracospic.
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Objective To investigate the myocardial protective effect of isehemic post-conditioning in total repair for tetralogy of fallot,in order to improve short-term prognosis of infant patients.Methods 64 cases of TOF infant patients were randomly divided into two groups,32 cases in the control group:conventional surgery without ischemic post-conditioning,and other 32 cases in the experimental group:given three cycles of ischemic post-conditioning.Then the clinical indieators:cardiopulmonary bypass time,aortic cross-clamping time,automatic re-jump rate,the latter parallel to the off-line time,the off-line blood pressure,the offline dopamine usage,extubation time,ICU stay time,postoperative complications,and the testing laboratory indicators:the cTnI and CK-MB levels in plasma after anesthesia induction,10min after aortic cross-clamping,10min after aortic opening,ICU1h,1d after surgery,and 2d after surgery were observed.Results Two patients were died and,mortality rate was 3.1%.The remaining patients were discharged from hospital.Laboratory indicators of the control group and the experimental group had significant differences (all P＜0.05),while the clinical indicators of the two groups had no significant differences(all P＞0.05).But for the sub-group which the aortic cross-clamping time were more than 60min,the clinical indicators were significantly different(all P＜0.05).Conclusion Ischemic post-conditioning could enhance myocardial protection in total repair for tetralogy,of fallot.for the cases aortic cross-clamping time was more than 60min,their clinical meanings were more obvious.
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Objective The early causes of death were analyze in 2349 patients who had undergone heart valve replacement.Methods Methods From January 1995 to December 2007,2349 patients with heart valve diseases received heart valve replacement.1109 cases were male and 1240 were female.The mean age of the patients was(41±19)years old.1962 cases had rheumatic heart valve disease,308 had congenital heart valve disease,39 had infective endocarditis,29 underwent reintervention by heart valve replacement,11 had Marfan syndrome.34 cases with coronary heart disease underwent heart valve prosthesis implantation and coronary artery bypass grafting.Mitral valve replacement(MVR)was performed in 1333 patients,aortic valve replacement(AVR)in 271,double valves replacement(DVR)in 736 and tricuspid valve replacement(TVR)in 9.There were 3075 mechanical valves and 10 bioprosthetic valves.Results From 1995 to 1999,death occurred in 16 of the 235 cases,early mortality rate was 6.81%.From 2000 to 2004,death occurred in 35 of the 1087 cases,early mortality rate was 3.22%.From 2005 to 2007,there were 29 deaths among 1027 cases,with an early mortality rate of 2.82%.Overall early mortality rate was 3.40%.The early mortality rate was 2.32%(31 in 1333 cases)in patients who underwent MVR,3.32% (9 in 271)in patients who underwent AVR,5.24%(40 in 736)in patients who underwent DVR,5.50%(7 in 127)with LVEDD≥70 mm,4.60%(14 in 304)with LVEF<0.40,2.14%(9 in 419)with NYHA class II,2.42%(37 in 1529)with NYHA class Ⅲ,and 8.48%(34 in 401)with NYHA class IV.The causes of 80 deaths were low cardiac output syndrome in 31 cases(38.8%),renal failure in 14 cases(17.5%),arrhythmia in 10 cases(12.5%),pulmonary infections in 8 cases (10.0%).cerebrovascular accidentin 5(6.3%),left ventricular rupture in 5(6.3%),multisystem and organ failure in 5(6.3%),and other cause in 2 cases(2.5%).Conclusion The causes of early death after heart valve replacement are low cardiac output syndrome,renal failure,arrhythmia,pulmonary infection,cerebrovascular accident,left ventricular rupture and multisystem and organ failure.