Effects of heart valve replacement under extracorporeal circulation on left ventricular function and regulatory T cells in elderly patients with rheumatic heart disease / 中华老年医学杂志

ABSTRACT

Objective:To assess the effects of heart valve replacement under extracorporeal circulation(ECC)on left ventricular function and regulatory T cells in elderly patients with rheumatic heart disease(RHD).Methods:113 elderly patients with rheumatic heart disease receiving ECC heart valve replacement at our hospital from September 2018 to September 2020 were selected retrospectively as subjects.Another 113 healthy people from the same period were selected as the control group.Patients in the observation group received ECC heart valve replacement.Left heart function and regulatory T cells were compared between the two groups.Results:Before surgery, the left atrial transverse diameter(LA)of RHD patients was significantly increased compared with the control group[(56.2±9.3)mm vs.(29.4±3.5)mm, t=28.670, P<0.001], and the left ventricular end diastolic diameter(LVDD)[(32.4±7.7)mm vs.(38.4±8.5)mm, t=5.561, P<0.001], left ventricular ejection fraction(LVEF)[(58.4±11.5)% vs.(65.6±10.5)%, t=4.915, P<0.001]and cardiac output(CO)[(3.7±2.6)L/min vs.(4.7±1.6)L/min, t=3.482, P<0.001]were significantly decreased compared with the control group.There were no significant changes in left heart function parameter values 10 min and 1 day after surgery(all P>0.05).One month after surgery, the inner diameter of pulmonary artery(PA)[(25.2±3.8)mm vs.(31.2±5.6)mm, t=9.659, P<0.001]and LA[(46.2±7.8)mm vs.(56.2±9.3)mm, t=8.758, P<0.001]were decreased compared with those before surgery, while changes in right ventricular end diastolic inner diameter(RVDD)and left ventricular end diastolic inner diameter(LVDD)were not significant, and there were no significant differences in LVEF, CO and LVFS(all P>0.05).The proportion of CD25 + CD4 + T cells in lymphocytes and the proportion of CD4 + CD25 + Foxp3 + Treg cells in CD4 + T cells in RHD patients before surgery were significantly lower than those in the control group( P<0.01).The proportions decreased 10 min and 1 day after surgery, but increased 3 days after surgery and returned to preoperative levels 7 days after surgery, but were still significantly lower than those in the control group( P<0.05). Conclusions:After ECC heart valve replacement in elderly RHD patients, the left atrium will shrink for a short time and tricuspid regurgitation can recover, with reduced damage of cellular immune function, but its contractile function remains unchanged.