Safety evaluation of patients with heart valve replacement undergoing general surgery / 中国实用外科杂志

ABSTRACT

OBJECTIVE: To evaluate the safety in patients with heart valves replacement undergoing general surgery.METHODS: From 2010 to 2016,the clinical data of demographic characteristics,comorbidities,preoperative laboratory tests,and surgical operation related information of 164 cases with heart valves replacement after general surgery in Department of General Surgery,Zhongshan Hospital,Fudan University,were collected retrospectively.Univariate and multivariate analysis were applied to identify the risk factors associated with major bleeding events and non-hemorrhagic complications.RESULTS: Among 164 cases,12 patients(7.3%) presented major bleeding events,and 27 patients(16.5%)presented non-hemorrhagic complications.Seven patients(4.3%) suffered grade Ⅲ perioperative complications and one patient(0.6%) died(grade V).The incidence of major bleeding events was significantly higher in emergent patients than in elective surgery(25.0% vs.4.9%,P=0.007),and there was no significant difference in the incidence of nonhemorrhagic complications(15.0% vs.16.7%,P=1.000).Significant risk factors for major bleeding events included emergency surgery [odds ratio(OR) 6.455,95% confidence interval(CI) 1.672-24.472,P=0.008],operative time≥60 minutes(OR=14.989,95%CI 1.683-2015.140,P=0.009),as well as aortic valve replacement(OR=3.408,95%CI 1.001-12.191,P=0.050).Significant risk factors for non-hemorrhagic complications were gastrointestinal surgery(OR=4.323,95% CI 1.740-11.629,P=0.002) and atrial fibrillation(OR=2.717,95% CI 1.053-7.022,P=0.037).CONCLUSION: Patients with heart valve replacement can undergo elective general surgery safely.The risk of hemorrhagic complications in emergency surgery is acceptable,as long as the standardized perioperative anticoagulation and antithrombotic management is carried out.