Objective To explore the affecting factors on sinus rhythm maintenance after electric cardioversion for patients with atrial fibrillation (Af) after cardiac valve replacement. Methods One hundred fifty two valvular disease patients with Af after cardiac valve replacement were randomized to 2 groups: Amiodarone group and control group (without anti arrhythmic drugs) after cardioversion. Af recurrence was observed during one year follow up. Results (1) No significant difference of Af recurrence betwe...
ObjectiveThrough comparing the efficacy of levosimendan with dopamine for severe valvular disease patients with atrial fibrillation surgery to explore the efficacy and safety of levosimendan used in cardiac surgery. MethodsWe allocated 48 severe valvular disease patients with atrial fibrillation surgery into a dopamine group (24 patients with 15 males and 9 females at age of 55.0 ± 17.4 years) and a levosimendan group (24 patients with 18 males and 6 females at age of 52.3 ± 16.2 years) by random digital table in the Affiliated Hospital of Luzhou Medical College between February and June 2014. The effects of the two groups were compared. ResultsHospitalization time (18.7±8.6 d vs 20.6±7.5 d, t=11.52, P=0.02) and the incidence of acute kidney injury(1/24 vs 5/24, χ2=25.30, P=0.01) in the levosimendan group were lower than those in the dopamine group. There was no statistical difference between the two groups in other early clinical outcomes. At each postoperative time point, there was no statistical difference in creatine kinase isoenzyme (CK-MB) between the two groups. While 6 to 48 hours after operation, there were significant differences in cardiac troponin (cTnI) and brain natriuretic peptide(BNP) level between the two groups (P < 0.05). Five days after operation, the left ventricular ejection fraction(LVEF) in the levosimendan group was higher than that in the dopamine group with statistical difference. ConclusionLevosimendan used for severe valvular disease with atrial fibrillation surgery is safe and effective, and has certain myocardial protection and renal protection effect, while its mechanism still needs further study.
ObjectiveTo explore whether preoperative coronary angiography could increase the incidence of postoperative acute kidney injury for patients with valve replacement. MethodsA total of 638 patients underwent routine cardiac valve replacement in our hospital from January 2013 through September 2015. There were 118 patients with preoperative coronary angiography (a coronary angiography group), and 520 patients without coronary angiography (a non-coronary angiography group). Serum creatinine (Scr), urea nitrogen(Bun), brain natriuretic peptide (BNP), creatine kinase myocardial band (CK-MB), cardiac troponin I (cTnI) values were recorded at 4 time points:before surgery (T0), after surgery 12 h (T1), 24 h (T2), 48 h (T3). The number of patients with acute kidney injury at the time of 48 hours after surgery was recorded. ResultsScr values (91.6±37.7 μmol/L vs. 81.0±27.4 μmol/L, 84.9±23.6 μmol/L vs. 73.5±25.3 μmol/L) increased in the patients who did not undergo coronary angiography at the time of 24 hours and 48 hours after cardiac surgery compared with the patients with coronary angiography with statistical differences. While there was no statistical difference in the incidence of acute kidney injury between the two groups. The cardiac enzymes had no statistical difference between the two groups. ConclusionPreoperative coronary angiography does not increase the probability of postoperative acute kidney injury.
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.