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1.
Rev. bras. cir. cardiovasc ; 37(1): 88-98, Jan.-Feb. 2022. tab, graf
Article in English | LILACS-Express | LILACS | ID: biblio-1365530

ABSTRACT

Abstract Objectives: Bicuspid aortic valve (BAV) is an important aetiology of aortic stenosis and the use of transcatheter aortic valve implantation (TAVI) has not been fully explored in this cohort. This systematic review and meta-analysis compared the outcomes of TAVI in stenotic BAV against tricuspid aortic valve (TAV). Methods: An electronic literature search was performed in PubMed, MEDLINE, EMBASE, and Scopus to identify all studies comparing TAVI in stenotic BAV versus TAV. Only studies comparing TAVI in BAV versus TAV were included, without any limit on the study date. Primary endpoints were 30-day and 1-year mortality, while secondary endpoints were postoperative rates of stroke, acute kidney injury (AKI), and permanent pacemaker (PPM) requirement. A trial sequential analysis (TSA) was performed for all endpoints to understand their significance. Results: Thirteen studies met the inclusion criteria (917 BAV and 3079 TAV patients). The BAV cohort was younger (76.8±7.43 years vs. 78.5±7.12 years, P=0.02), had a higher trans-aortic valve gradient (P=0.02), and larger ascending aortic diameters (P<0.0001). No significant difference was shown for primary (30-day mortality [P=0.45] and 1-year mortality [P=0.41]) and secondary endpoints (postoperative stroke [P=0.49], AKI [P=0.14], and PPM requirement [P=0.86]). The BAV group had a higher rate of significant postoperative aortic regurgitation (P=0.002). TSA showed that there was sufficient evidence to conclude the lack of difference in PPM requirements, and 30-day and 1-year mortality between the two cohorts. Conclusion: TAVI gives satisfactory outcomes for treating stenotic BAV and should be considered clinically.

2.
Article in Chinese | WPRIM | ID: wpr-920835

ABSTRACT

@#The incidence of valvular heart disease (VHD) increases with age, and its principal therapy is valve replacement. However, in recent years, the emergence of transcatheter interventions has changed the traditional therapy, making high-risk patients of surgery see dawn of hope. 3D printing technology has developed rapidly since it was applied to the medical field in 1990. Moreover, it has been widely applied in many surgical majors via refined reduction technology. However, the application of 3D printing technology in cardiovascular surgery is still in the preliminary stage, especially in the field of VHD. This article aims to review basic principles of 3D printing technology, its advantages in the therapy of VHD, and its current status of clinical application. Furthermore, this article elaborates current problems and looks forward to the future development direction.

3.
Article in Chinese | WPRIM | ID: wpr-908085

ABSTRACT

Objective:To explore and analyze the effect of therapeutic communication system (TCS) intervention mode on Therapeutic effect and quality of life in patients with cardiac valve replacement.Methods:A total of 103 patients with cardiac valve replacement admitted from February 2018 to February 2019 were selected and divided into observation group (51 cases) and control group (52 cases) according to the random number table method. Patients in the control group were treated with staged rehabilitation intervention, while patients in the observation group were treated with staged rehabilitation combined with TCS intervention mode. Patients' prognosis, the score of Short Form 36-item Health Survey (SF-36) before and after intervention, the changes in the score of the Morisky label Scale (MMAS-8) before and after intervention, and perioperative indicators were recorded and compared between the two groups.Results:The quality of life scores of the observation group at 1 month,3 months and 6 months after intervention were (64.42±9.51), (76.23±9.19), (87.24±9.21) points, which were significantly higher than (58.73±9.38), (61.23±9.29), (76.29±9.42) points of the control group ( t values were 3.057, 8.237, 5.964, P<0.05);and also higher than those before intervention (54.29±9.14, 54.45± 9.31), the difference was statistically significant ( F values were 11.358, 7.581, P<0.001); the ICU hospitalization time (43.25±1.72),bed rest time (42.13±8.32) and hospitalization time (16.32±4.20) days in the observation group were significantly lower than (54.34±1.93), (72.33±8.54), (21.24±4.36) days in the control group, and the difference was statistically significant ( t values were 30.766, 18.174, 5.831, P<0.001); the drug compliance (7.21±0.17) was significantly higher than that of the control group (6.01±0.34) ( t value was 22.588, P<0.001). Conclusion:Stage rehabilitation combined with TCS intervention mode can effectively improve the prognosis and perioperative indicators of patients with heart valve, and improve the quality of life of patients, which is worthy of clinical application.

4.
Article in Chinese | WPRIM | ID: wpr-912297

ABSTRACT

Objective:To evaluate the long-term results of bipolar radiofrequency(BRF) ablation in restoring sinus rhythm in patients with permanent atrial fibrillation(AF) undergoing surgery for cardiac surgery.Methods:This retrospective study sample consisted of 268 patients with LSP-AF underwent cardiac operations concomitant BRF maze Ⅳ procedure. Data were collected prospectively on perioperative outcomes, rhythm status, survival, and clinical events.Results:15 patients died in the early postoperative period, perioperative mortality rate was 5.5%. The rate of stable sinus rhythm(sSR)was 86.6%, 75.4%, 67.7%, 57.8% in 1, 2, 5, 8 years after operation. Multivariate analysis proved the size of the left atrium( HR=1.073, P<0.001) and duration of AF( HR=1.070, P=0.025) to be an independent predictor of the radiofrequency ablation outcome. Conclusion:Bipolar radiofrequency maze procedure can effectively eliminate AF, maintain long-term of sinus rhythm. Bipolar radiofrequency maze procedure is a safe, easy and effective surgical option for the treatment of AF, with satisfactory long-term results, is worthy of promotion.

5.
Article in Chinese | WPRIM | ID: wpr-923267

ABSTRACT

@#According to new clinical evidence, the European Society of Cardiology (ESC) and European Association for Cardio-Thoracic Surgery (EACTS) updated and published 2021 ESC/EACTS guidelines for the management of valvular heart disease. This new guideline gives recommendation for clinical assessment, internal treatment and intervention for patients with valvular heart disease with/without comorbidities, which is a globally approbatory reference for clinical practice. This article summarized the updated contents of the new guideline in terms of transcatheter therapy for valvular heart disease.

6.
J Ayurveda Integr Med ; 2020 Jan; 11(1): 78-81
Article | IMSEAR | ID: sea-214115

ABSTRACT

Kabhatika Hridroga (valvular heart disease) embodies a significant part of cardiovascular disease. Thereare many causes for valvular heart disease of which, the rheumatic fever is an important one. This studyis a case report of a patient awaiting mitral valve transplant for valvular heart disease (i.e., mitral stenosisattributed to rheumatic fever), who responded well to Ayurvedic management. After 11 months oftreatment, 3D cardiovascular cartography showed increase in mitral valve area from 1.3 sq cm to 3.52 sqcm (normal size is 4e6 sq cm). The present case report showed that Ayurveda has a great potential forthe treatment of valvular heart disease and merits further research.© 2018 Transdisciplinary University, Bangalore and World Ayurveda Foundation. Publishing Services byElsevier B.V. This is an open access article under the CC BY-NC-ND license (http://creativecommons.org/licenses/by-nc-nd/4.0/).

7.
Article in Chinese | WPRIM | ID: wpr-837692

ABSTRACT

@#Objective    To investigate the clinical effect of Maze Ⅳ in the treatment of elderly patients with valvular heart disease and persistent atrial fibrillation (AF). Methods    We retrospectively analyzed the clinical data of 78 elderly patients with cardiac valve disease combined with persistent AF in our hospital from 2017 to 2018. The patients were allocated to two groups including a trial group (n=37) and a control group (n=41). There were 21 males and 16 females aged 61 to 74 (65.2±2.5) years in the trial group. There were 23 males and 18 females aged 62 to 76 (64.8±3.3) years in the control group. The clinical effects of the two groups were compared. Results    There was no statistical difference in baseline data between the two groups (P>0.05). The aortic occlusion time, extracorporeal circulation time, and operation time of the trial group were longer than those of the control group with statistical differences (P<0.05). There was no statistical difference in postoperative ventilator assistance time, complication rate, mortality, ICU retention time, perioperative drainage, red blood cell transfusion volume, or length of hospital stay between the two groups (P>0.05). At the time of discharge, postoperaive 1-month, 3-month, 6-month, and 12-month, the maintenance rates of sinus rhythm in the control group were statistically different from those of the trial group (P<0.05). Compared with the control group, left atrial diameter, left ventricular end diastolic diameter and the decrease of pulmonary artery systolic blood pressure were statistically different (P<0.05). Conclusion    Maze Ⅳ is safe and effective in the treatment of elderly patients with valvular heart disease and persistent AF, which is conducive to the recovery and maintenance of sinus rhythm, and is beneficial to the remodeling of the left atrium and left ventricle and the reduction of pulmonary systolic blood pressure with improvement of life quality of the patients.

8.
Article in Chinese | WPRIM | ID: wpr-829204

ABSTRACT

@#Objective    To analyze the recovery rule of atrial contractility (AC) function after Maze Ⅳ procedure of valvular atrial fibrillation (AF). Methods    In our hospital from March 2016 to April 2018, 103 patients who underwent cryoablation Maze Ⅳ procedure due to mitral valve lesions associated with persistent or long-term persistent AF were enrolled. There were 42 males and 61 females, with an average age of 58.5±9.1 years. Electrocardiogram and echocardiography were followed up at discharge and 1, 3, 6, 12 months after procedure. A multivariate Cox analysis of predictive factors for AC recovery was applied. Results    All the 103 patients were followed up for 1 year. The recovery rate of AC increased gradually after operation. It was not until 3 months after procedure that most of the right atrial contractility (RAC) was accompanied by synchronous recovery of the corresponding left atrial contractility (LAC, Kappa coefficient≥0.40, P<0.05). However, the coexistence of sinus rhythm (SR) and bilateral AC was not consistent well until 1 year after operation (Kappa coefficient≥0.40, P<0.05). One year after procedure, the recovery rates of SR and bilateral AC were 86.4% (89/103) and 66.0% (68/103) respectively. By Cox multivariate regression analysis, longer preoperative AF duration (P=0.040), larger preoperative left atrial diameter (LAD, P=0.003), and AC deletion 3 months after surgery (P=0.037) were predictive factors for AF recurrence in the middle and advanced stages (>3 months) after Maze surgery. At the same time, longer preoperative AF duration and larger preoperative LAD were also negative predictors of middle and late recovery of LAC and bilateral AC (All P<0.05). Receiver operating characteristic curve analysis showed that the best critical value of preoperative AF time and preoperative LAD for prediction of AC recovery was 37 months (sensitivity 99.6%, specificity 76.3%) and 60.5 mm (sensitivity 98.5%, specificity 78.9%), respectively. Conclusion    The recovery of AC after Maze procedure is a dynamic improvement process. Early recovery of AC is beneficial to the stable maintenance of SR in the future. Prolonged duration of AF and enlarged LAD have adverse effects on the outcome of Maze Ⅳ procedure.

9.
Article in Chinese | WPRIM | ID: wpr-847301

ABSTRACT

BACKGROUND: Patients with mitral valve disease have a higher incidence of atrial fibrillation after mitral valve replacement and mitral annuloplasty. Maze surgery is the gold standard for surgical treatment of atrial fibrillation. The effect of artificial valve and valve ring on maze surgery is not clear. OBJECTIVE: To evaluate the changes of sinus rhythm-left atrial contractive function after surgical maze ablation of valvular atrial fibrillation and whether valve replacement or valve ring implantation affects the recovery of sinus rhythm-left atrial contractive function. METHODS: From October 2013 to October 2017, 324 patients who underwent surgical maze ablation due to mitral valve lesions associated with persistent or long-term persistent atrial fibrillation in the General Hospital of Northern Theater Command were enrolled. All patients were treated with artificial valve replacement or artificial valve ring implantation after maze operation. The patients were followed up by electrocardiogram and echocardiography at discharge and 1, 3, 6, 12 and 24 months after procedure. A multivariate Cox analysis of predictive factors for left atrial contractive function recuperation was applied. This study was approved by the Medical Ethics Committee of General Hospital of Northern Theater Command (original General Hospital of Shenyang Military Region of Chinese PLA). RESULTS AND CONCLUSION: (1) Two patients (0.6%) died during the perioperative period, and the remaining 322 patients were followed up for 2 years. There were no adverse events related to artificial materials during the follow-up. (2) The recovery rate of left atrial contractive function increased gradually after procedure. The coexistence consistency of left atrial contractive function and sinus rhythm was good until 1 year after surgery (Kappa coefficient = 0.75, P 3 months) after surgical maze ablation (all P values 0.05). (4) ROC curve analysis showed that the optimal critical value of preoperative atrial fibrillation time and preoperative left atrial diameter for prediction of left arterial contractive function recovery was 36.5 months (sensitivity 90.5%, specificity 93.7%) and 60.5 mm (sensitivity 93.8%, specificity 85.0%) respectively. (5) These results suggest that the recovery of left atrial contractive function after surgical maze ablation is a dynamic improvement process. Early recovery of left atrial contractive function is beneficial to maintaining stable sinus rhythm in the future. Prolonged duration of atrial fibrillation, enlarged left atrial diameter, and cryoablation mode may have adverse effects on surgical maze ablation. Valve ring implantation or valvular replacement does not affect the efficacy of surgical maze ablation.

10.
Article in Japanese | WPRIM | ID: wpr-825972

ABSTRACT

Objectives : We sought to present data relative to valvular heart surgeries from the Japan Cardiovascular Surgery Database in 2017 and 2018 to show current status and trend in Japan. Methods : We extracted data relative to cardiac valve surgeries performed in 2017 and 2018 from the Japan Cardiovascular Surgery Database. We obtained total number of aortic valve replacement procedures and showed trend for these 6 years from 2013 to 2018. The operative mortality rates were shown for representative valve procedures stratified by age group with the aim of showing a bench mark of Japan. Data regarding minimally invasive procedures and transcatheter aortic valve implantation which the Japan Cardiovascular Surgery Database can provide were also presented. Results : Despite dramatic increase of number of transcatheter aortic valve implantation in 2017 and 2018 compared to in 2015 and 2016, surgical aortic valve replacement also increased from 26,054 to 28,202. Regarding the operative mortality of first time valve procedures, it was 1.8% in isolated aortic valve replacement, 0.9% in isolated mitral valve repair, 8.2% in mitral valve replacement with biological prostheses, and 4.6% with mechanical prostheses. For first time valve procedures with concomitant coronary artery bypass, the operative mortality was 5.2% in aortic valve replacement, 4.9% in mitral valve repair. Regarding prosthetic valve selection, 72.6% of patients had biological prosthesis for aortic valve replacement procedures in their 60's, showing trend of increasing percentages of biological valve choice. Regarding minimally invasive procedure, 31.8% of first time isolated mitral valve plasty were performed via right thoracotomy. Though patients who underwent surgery via right thoracotomy had better clinical outcomes, it was also apparent that the patients who underwent surgery via right thoracotomy had lower operative risk profile. Aortic clamp time and cardiopulmonary bypass time were longer in the right thoracotomy patients. 6.3% of the patients who had isolated aortic valve replacement underwent surgery via right thoracotomy. The right thoracotomy aortic valve replacement patients had better clinical outcomes and had more percentage of lower risk profile. The overall mortality of transcatheter aortic valve implantation and surgical aortic valve replacement were 1.5% and 1.8%, respectively. Conclusion : We reported data related to heart valve surgery in 2017 and 2018 from the Japan Cardiovascular Surgery Database.

11.
Article in Chinese | WPRIM | ID: wpr-823419

ABSTRACT

@#Objective 聽 聽To investigate the influence of mechanical and biological valves on clinical benefits of elderly patients with valvular heart disease. Methods 聽 聽We retrospectively analyzed the clinical data of 280 elderly patients with valvular heart disease treated by valve replacement between 2008 and 2014 year. The patients were divided into two groups by tendency score matching including a group A with biological valves and a group B with mechanical valves. Finally, there were 96 patients in each group. There were 43 males and 53 females at age of 64.41卤6.52 years in the group A, 44 males and 52 females at age of 64.07卤6.20 years in the group B. Results 聽 聽The bleeding rate of skin and mucosa of the group B was significantly higher than that of the group A (P<0.05). There was no statistical difference in mortality within 30 days after operation, all-cause mortality, re-hospitalization rate, re-valve replacement rate, combined atrial flutter/atrial fibrillation ratio, drug use, incidence of cerebral infarction, cerebral hemorrhage, new peripheral vascular embolism and visceral hemorrhage, heart function (NYHA) classification, the cumulative survival rate of all the patients during follow-up (P=0.63), or the cumulative survival rate of the patients with no thrombus/hemorrhage (P=0.75) between the two groups (P>0.05). Conclusion 聽 聽Mechanical valve replacement and bioprosthetic valve replacement in the treatment of valvular heart disease in the elderly can achieve similar clinical benefits and both have clinical application value.

12.
Journal of Medical Postgraduates ; (12): 201-205, 2020.
Article in Chinese | WPRIM | ID: wpr-818403

ABSTRACT

Artificial heart valve has been used for more than 50 years, which mechanical valve has significant clinical effect in the treatment of valvular disease and has been widely used in cardiac-disease patients. After mechanical valve replacement, some female patients in childbearing age still have a family planning. Meanwhile, anticoagulants must be taken for lifelong to prevent thrombosis and thromboembolism. However, pregnancy is a special physiological preocess and anticoagulant therapy has a certain risk to both mothers and infants. Because the blood during pregnancy is in a hypercoagulable state, anticoagulant therapy has its particularity for pregnant patients after cardiac mechanical valve replacement. In addition, some anticoagulant drugs can affect fetal development. As a result, there is a lack of ideal and consistent anticoagulation scheme at present. In this paper, we review the related studies of anticoagulant drugs and anticoagulant therapy during pregnancy after mechanical valve replacement.

14.
Article | IMSEAR | ID: sea-211730

ABSTRACT

Background: Rheumatic heart disease (RHD) is a common form of heart valve disease associated with episodes of rheumatic fever. Despite the developments achieved in the field of cardiology, the consequences of acute rheumatic fever remain significantly high in developing countries like India.  Objectives of current study aims to evaluate the pattern of valvular involvement in patients of RHD in Western Rajasthan assessed by echocardiography.Methods: This is an observational study conducted at the department of Cardiology, Dr. S. N. Medical College, Jodhpur, India between September 2015 and February 2019. The study includes analysis of echocardiograms of RHD patients performed during this period.Results: Total 502 echocardiograms of RHD patients between 4 and 75 years of age with mean age of 35.6±11.6 years were evaluated, in which the most common age group was 21-40 years.  There were 191 (38.04%) males, and 311(61.95%) females. Mitral valve was most commonly involved in which mitral stenosis (MS) was seen in 345(68.72%) and mitral regurgitation (MR) was seen in 350(69.72%) patients. Aortic stenosis (AS) was seen in 61(12.15%) and aortic regurgitation (AR) was found in 224(44.62%) cases. Organic tricuspid valve (TV) disease was seen in 18(3.58%). In combined valvular involvement MS+MR was seen in 234(46.61%) cases; followed by MR+AR in 171(34.06%); MS+AR in 161(32.07%); AS+AR in 62(12.35%); MR+AS in 46(9.16%) and MS+AS in 42(8.36%) subjects.Conclusion: The echocardiographic pattern of RHD patients of Western Rajasthan showed a predominant involvement of mitral valve, followed by aortic and tricuspid valves. Further amongst multi-valvular involvement the sequence was predominantly MS+MR followed by MR+AR, MS+AR, AS+AR, MR+AS, and MS+AS.

15.
Article | IMSEAR | ID: sea-194293

ABSTRACT

Background: Diseases of the heart valves constitute a major cause of cardiovascular morbidity and mortality worldwide with an enormous burden on healthcare resources. The present study was undertaken to study incidence and demography of valvular heart disease, to assess echocardiography and colour doppler findings of patients with valvular heart disease and to find out complications in patients with valvular heart disease.Methods: A hospital based longitudinal case study was undertaken at medicine department of Dr. V.M. Government Medical College, Solapur, Maharashtra, India for a period of two years. One hundred and twenty-four (124) patients attending OPD participated in the study.Results: In the present study, out of 124 patients, mitral valve was most commonly involved, 105(84.67%) and the least common involved was tricuspid 1(0.81%). The most common aetiology was rheumatic origin 75(94.94%). In the present study the most common complication was pulmonary hypertension 69(55.65%), followed by congestive cardiac failure (33.87%), acute pulmonary edema (12.09%), infective endocarditis (4.84%), cerebrovascular accident (4.03%), left atrial thrombus (3.23%) and death (3.23%).Conclusions: Multiple valves were affected in more than a third of all cases, although recent research in India continue to demonstrate a declining trend in the prevalence of RHD, rheumatic involvement is still the dominant form of valvular heart disease in India.

16.
Article | IMSEAR | ID: sea-200029

ABSTRACT

Atrial fibrillation is associated with high risk of ischaemic stroke which is considered a major fatal complication in atrial fibrillation. That’s why, anticoagulants were used to prevent this major complication. However, anticoagulants themselves are associated with their own complications. A systematic search of Embase, Medline and Google scholar were conducted. The included papers were extracted for outcomes related to the complications of each drugs. A Bayesian network meta-analysis based on Markov chain Monte Carlo simulation (MCMC) with 10000 burn-in iterations and 50000 inference iterations. We found eighteen papers that fit our inclusion criteria. Apixaban had the least risk of major bleeding compared to Warfarin [HR = 0.536, 95% (0.448, 0.652)] and the least risk of gastrointestinal hemorrhage. For stroke risk, the Rivaroxaban had the least risk compared to Warfarin [HR = 1.05, 95% (0.98, 1.14)]. For intracranial hemorrhage, dabigatran had the least risk of intracranial haemorrhage compared to Warfarin [HR = 0.46, 95% CrI (0.36, 0.61)]. For the thromboembolism risk, other non-vitamin k antagonist had the least risk of intracranial haemorrhage compared to Warfarin [HR = 0.523, 95% (0.095, 2.85)]. There were no conclusive results about the best anticoagulant drugs for non-valvular atrial fibrillation. Apixaban was the least among them to be associated with major bleeding, while rivaroxaban was ranked the first with least stroke complications. Furthermore, dabigatran was associated with less risk of intracranial haemorrhage compared to other anticoagulants.

17.
Article in Chinese | WPRIM | ID: wpr-751027

ABSTRACT

@#Objective    To summarize the individualized selection of surgical treatment strategies and the key points of perioperative management for patients with heart valve disease complicated with severe chronic heart failure. Methods    The clinical characteristics of 5 male patients with valvular heart disease complicated with severe chronic heart failure (CHF) were analyzed retrospectively from June 2017 to October 2018 in Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, with an average age of 60.21 years. Results    Five patients were given angiotensin receptor and neprilysin inhibitor (ARNI)-based anti-heart failure treatment after admission. The operation mode of these patients was decided to be valve replacement under cardiopulmonary bypass after individualized evaluation of patients’ improving symptoms. Three patients were treated with intra-aortic balloon pump (IABP) and continuous renal replacement therapy (CRRT) early after operation to assist patients in improving cardiac function. Five patients recovered oral anti-heart failure after awakening. All patients were discharged smoothly 2 weeks after operation. Conclusion    Individualized evaluation is needed for the choice of operation timing and mode, standardized preoperative treatment for heart failure, shortening the aortic blocking time during cardiopulmonary bypass, and early application of left ventricular adjuvant drugs or instruments are all important measures to help patients recover smoothly.

18.
Chinese Circulation Journal ; (12): 1098-1101, 2018.
Article in Chinese | WPRIM | ID: wpr-703933

ABSTRACT

Objectives: To compare the short-term and mid-term outcomes of elderly patients (>60 years old) with valvular heart disease (VHD) underwent bioprosthetic or mechanical valve replacement. Methods: Between January 2007 and December 2010, 559 elderly patients underwent valve replacement in Fuwai Hospital, clinical data of these patients were analyzed retrospectively (319 cases with bioprostheses vs 240 cases with mechanical prostheses). After matching, data from 192 cases in each group were compared. Results: The mortality within 30 postoperative days were similar (2.1% in both groups). All-cause death during follow up was also similar between the two groups (13.6% vs 13.7%, P=0.98). There was no statistically significant difference on the hospital readmission rate between the two groups (25.5% vs 35.9%, P=0.17). No significant difference was found on thromboembolic and hemorrhagic events free survival between the two groups (144 cases vs 138 cases, P=0.78). Conclusions: Short-term and mid-term survival and readmission rate are similar for the elderly VHD patients receiving bioprosthetic or mechanical valve replacement.

19.
The Journal of Practical Medicine ; (24): 1846-1849, 2017.
Article in Chinese | WPRIM | ID: wpr-616760

ABSTRACT

Objective To investigate the Cardioprotective effects of sevoflurane postconditioning on surgery patients undergoing cardiopulmonary bypass with diabetes mellitus ,in order to provide theoretic basic for clinical practic. Methods 180 patients of undergoing cardiopulmonary bypass sugery were divided into 3 groups:A group:64 patients undergoing heart valve replacement with Type II diabetes. B group:64 patients Pa-tients undergoing heart valve replacement without diabetes ,the group A and B were treated by sevoflurane post-conditionging for 10 minutes before the end of cardiopulmonary bypass. C group:60 patients undergoing heart valve replacement without diabetes,no sevoflurane postconditionging;Three groups of patients detect perioperative tro-ponin T and Creatine Kinase Isoenzyme-MB ,observed and following up the occurrence of postoperative com-plications. Results CK-MB and cTnT were compared at 8 and 24 hours after operation:two biochemical indi-cators of group A and C at different time points after operation were significantly higher than those in group B (P < 0.05),With significant statistical difference , The number of patients with heart failure and malignant arrhythmia in group A and C was higher than group B(P < 0.05),Differences in 30 day mortality and other clinical data between the three groups were not statistically significant. Conclusion Sevoflurane postconditionging has significant myocardial protection effect for patients undergoing valve replacement surgery without diabetes , however ,the myocardial protective effect of patients who undergoing valve replacement surgery with diabetes was weakened.

20.
Article in Chinese | WPRIM | ID: wpr-611631

ABSTRACT

Objective·To analyse the outcomes of tricuspid valve replacement (TVR) for secondary tricuspid regurgitation (STR) late after left-sided valve surgery during perioperative period and mid-term follow-up,investigate mechanisms of STR and surgical risk factors.Methods·A total of 85 consecutive patients who underwent the TVR surgery were analyzed.The perioperative and mid-term clinical outcomes were retrospectively investigated.The data were divided into bioprosthesis group (n=50) and mechanical prosthesis group (n=35) according to the prosthesis used,and divided into right anterolateral thoracotomy(RALT) group (n=51) and stemotomy(S) group (n=34) according to the surgical incision.Results·In-hospital mortality was 8.2% (7/85).There was no significant difference in the mortality with different choice of bioprosthetic or mechanical valve (4/50 vs 3/35,x2=0.009,P=1.000);while there was significant difference between S group and RALT group (6/34 vs 1/51,x2=6.642,P=0.015).Seven cases all died of right heart failure and severe low cardiac output syndrome.Five (5.9%) cases died in perioperative within 30 in-hospital days and 2 (2.4%) cases died after 30 in-hospital days.Seventy-four cases were followed up.With the follow-up of (31.5±23.1) months,there were 4 case of late deaths(5.4%),all of whom were mechanical prosthesis,of whom 3 died in cardiac related death and 1 died in later period bowel cancer.Seventy cases survived in New York Heart Association (NYHA) class Ⅰ-Ⅱ with no coagulated accident and redo-TVR.Conclusion·The perioperative and mid-term clinical outcomes are satisfied in timely and reasonable TVR with the standard follow-up for STR late after left-sided valve surgery.Right anterolateral incision is recommend for isolated TVR.

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