ObjectiveTo investigate clinical outcomes and summarize perioperative management experience of heart valve replacement (HVR)in elderly patients. MethodsWe retrospectively analyzed clinical data of 47 elderly patients undergoing HVR in Affiliated Hospital of Xuzhou Medical College from January 2011 to May 2014. There were 19 male and 28 female patients with their age of 60-79 years. There were 35 patients with rheumatic heart disease, 10 patients with degenerative valvular disease, and 2 patients with congenital bicuspid aortic valve. Preoperatively, there were 23 patients in NYHA functional class Ⅱ, 19 patients in class Ⅲ, and 5 patients in class Ⅳ. All the patients received HVR under cardiopulmonary bypass (CPB), and some patients received concomitant tricuspid valvuloplasty (TVP), left atrial thrombectomy or coronary artery bypass grafting (CABG). Postoperative mortality, morbidity and heart function improvement were evaluated. ResultsTwenty-seven patients received mitral valve replacement (MVR), 15 patients received aortic valve replacement (AVR), and 5 patients received MVR+AVR. Concomitantly, 4 patients received TVP, 3 patients received left atrial thrombectomy, and 6 patients received CABG. Operation time was 138-412 (196±52)minutes, CPB time was 48-301 (108±33)minutes, aortic cross-clamping time was 34-196 (87±21)minutes, and length of hospital stay was 12-31 (19±5)days. There was no intraoperative death, and 2 patients (4.3%)died postoperatively because of left ventricular failure and multiple organ dysfunction syndrome respectively. Twenty-three patients (51.1%)had postoperative complications including respiratory failure in 6 patients, pulmonary infection in 5 patients, arrhythmias in 5 patients, wound infection in 2 patients, pleural effusion in 2 patients, low cardiac output syndrome in 2 patients, and acute renal failure in 1 patient. Forty-five survival patients were followed up by telephone, online video and at the outpatient department for 1-32 months, and follow-up rate was 100%. There were 11 patients in NYHA functional classⅠ, 32 patients in class Ⅱ, and 2 patients in class Ⅲ. ConclusionAccording to clinical characteristics of elderly patients with valvular heart disease, meticulous surgical techniques and perioperative management can effectively reduce mortality and morbidity after HVR.
Technical advances both in cardiac surgery and relating to anesthesia,cardiopulmonary bypass and myocardial protection have significantly improved the prognosis for patients combined with coronary heart disease and heart valve disease. In addition to technology, variable factors that affect operative survival following combined operation include the severity of valvular disease, the number of coronary vessels affected, impairment of left ventricular function and both age and gender differences. In this article, we review the outcome of surgical intervention for heart valve disease combined with coronary heart disease and discuss future prospects in this field.
Objective To evaluate the left ventricular remodeling after valve replacement for valvular heart disease with giant left ventricle. Methods The clinical material of 92 patients with valvular heart disease and giant left ventricle after valve replacement was retrospectively reviewed. The results of ultrosonic cardial gram（UCG） and the changes of cardiac function before and after operation were compared. Results There was no operative death. The value of left ventricular end-diastolic dimension （LVEDD）, left ventricular end-systolic dimension （LVESD）, left atrial dimension （LAD）, left ventricular ejection fraction （LVEF）, left ventricular fractional shortening （LVFS）, stroke volume （SV） and cardiothoracic ratio in 2 weeks and 2 months after operation were more decreased than those before operation（P〈0. 05）. The value of LVEDD and LAD in 2 months after operation were much more decreased than those in 2 weeks after operation （P〈0. 05）. The cardiac function in early stage after operation was more decreased than that before operation,but the cases of cardiac functional class Ⅱ （38 cases, 41.3% ） in 2 months after operation was significantly more than those before operation （5 cases, 5.4 % ）. Conclusions The early effect of left ventricular remodeling is significant for valvular heart disease with giant left ventricle after valve replacement. The diameter of left ventricle and left atrial are significantly decreased after operation. The protection for cardiac function should be carefully taken in order to prevent the occurrence of complication after operation.
ObjectiveTo 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.MethodsThe 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.ResultsFive 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.ConclusionIndividualized 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.
ObjectiveTo investigate risk factors of in-hospital death of patient after heart valve replacement (HVR) in Xinjiang. MethodsWe retrospectively analyzed clinical data of 214 patients undergoing HVR in the First Teaching Hospital of Xinjiang Medical university from January 2011 to Month 2014. There were 96 male and 118 female patients with their age of 49.91±13.27 years. According to their postoperative prognosis, all the patients were divided into a death group (21 patients) and a survival group (193 patients). Risk factors of perioperative death were analyzed. ResultsIn-hospital mortality was 9.81% (21/214). There was statistical difference in preoperative prothrombin time (PT), incidences of left ventricular ejection fraction (LVEF)≤50%, NYHA classⅣ, pulmonary arterial pressure (PAP) > 60 mm Hg, cardiopulmonary bypass time≥2 hours, concomitant coronary artery disease and renal failure between the 2 groups (P < 0.05). Logistic regression analysis showed that shortened preoperative PT, PAP > 60 mm Hg, NYHA classⅣand LVEF≤50% were independently risk factors of in-hospital death after HVR (P < 0.05). ConclusionsIndependent risk factors of in-hospital death of patients after HVR in Xinjiang include shortened preoperative PT, PAP > 60 mm Hg, NYHA classⅣand LVEF≤50%. Heightened caution is needed for patients with above risk factors to receive HVR after correction of those risk factors.
Valvular heart disease is one of the common diseases in cardiac surgery. Surgery is the main treatment for valvular heart disease. Cardiac valve replacement surgery corrects the disordered haemodynamics, but the quality life of patients may be affected by multiple factors, such as the disease itself, treatment measures, long-term postoperative anticoagulant and follow-up. This article will provide an overview of the quality of life (origin and definition, evaluation) and the quality of life of patients after cardiac valve replacement (the purpose and significance of quality of life assessment, the quality of life of patients after cardiac valve replacement at different times and different dimensions, influencing factors of the quality of life of patients after surgery), aiming to provide clinical evidence for patients to make decisions before surgery and for clinical medical staff to take intervention measures for patients after surgery.
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.
Abstract： Objective To evaluate early clinical outcomes and short-term follow-up results of CL-V bileaflet prosthesis. Methods From April 2004 to May 2010， 38 patients with valvular heart diseases underwent mechanical heart valve replacement. Eighteen patients received CL-V bileaflet valve replacement （CL group） including 8 males and 10 females with their mean age of （47.4±6.2）years and mean body weight of （64.7±11.9） kg. Preoperatively，15 patients were in New York Heart Association （NYHA） classⅢ， and 2 patients were in NYHA classⅣ. Mitral valve replacement （MVR） was performed in 16 patients， mitral and aortic valve replacement（DVR） in 2 patients. A total of 20 CL-V bileaflet prostheses were implanted. Twenty patients received St. Jude bileaflet valve replacement （SJM group）including 9 males and 11 females with their mean age of （49.7±7.6） years and mean body weight of （66.1±11.1） kg. Preoperatively， 15 patients were in NYHA classⅢ， and 3 patients were in NYHA classⅣ. MVR was performed in 17 patients，aortic valve replacement （AVR） in 1 patient， and DVR in 2 patients. A total of 22 St. Jude bileaflet prostheses were implanted. Clinical outcomes， hear function， hemodynamics and blood compatibility were measured on the 7th postoperative day and 6 months during follow-up and compared between the two groups. Results There was no early mortality （＜30 d） or postoperative complication in either group. Follow-up rate was 100% and the mean follow-up duration was 19.8 （6-61）months. At 6 months after surgery， those patients who were preoperatively in NYHA classⅢ orⅣall improved to classⅠ orⅡ. In CL group， cardiothoracic ratio was 0.51±0.05， left atrium diameter （44.5±7.8） mm， left ventricular end diastolic diameter （LVEDD，46.6±4.1） mm， LVEF 65.3%±7.7%，and LVFS 35.0%±7.1%. In SJM group， cardiothoracic ratio was 0.51±0.06， left atrium diameter （45.8±9.6） mm， LVEDD （46.2±9.8） mm， LVEF 64.1%±9.0%，and LVFS 34.9%±4.7%， which were not statistically different from those parameters of CL group respectively （P＞0.05）. At 6 months after surgery， transthoracic echocardiography was used to compare hemodynamics of bileaflet prostheses with same size 27 mm in the two groups. Prosthetic transvalvular gradient was （5.1±0.9）mm Hg in CL group and （5.8±0.8） mm Hg in SJM group， and effective orifice area was （2.3±0.3）cm2 in CL group and（2.5±0.2）cm2 in SJM group，which were not statistically significant between the two groups （P＞0.05） respectively. In both groups， the level ofhemoglobin， lactate dehydrogenase and platelet at 6 months postoperatively were all within normal range and not statistically from those respective preoperative parameters（P＞0.05）. Hemolytic reaction and hemolytic anemia were not found. During early and short-term follow-up， there was no thromboembolic complications or anticoagulation-related severe bleeding events in the two groups with same anticoagulation intensity target （target INR value 1.5 to 2.5）. Conclusion Early clinical outcomes and short-term follow-up results of CL-V bileaflet prostheses are similar to those of St. Jude bileaflet prostheses. Postoperative patients have good clinical outcomes， hemodynamics and blood compatibility. Patients’ heart function significantly improve during short-term follow-up without valve-related complication. Mid-term and Long-term follow-up are further needed to demonstrate its good performance.
Objective To propose a whole-life cycle management model for valvular heart disease (VHD), systematically elucidate its underlying logic and implementation pathways, and concurrently review and analyze its preliminary application outcomes. Methods Since 2020, West China Hospital of Sichuan University has established a management system encompassing "assessment-decision-intervention-follow-up", including: (1) a risk-stratified, tiered management pathway; (2) six core functions ("promotion, screening, prevention, diagnosis, treatment, and rehabilitation") coordinated by disease-specific managers; (3) an intelligent decision support information platform; and (4) a collaborative network of multidisciplinary teams and regional academic alliances. To evaluate the effectiveness of this management model, we retrospectively included three cohorts: (1) the population screened by echocardiography from 2020 to 2024, analyzing the detection rate of aortic valve disease and risk stratification; (2) patients enrolled in the whole-life cycle management from April 2021 to December 2024, assessing follow-up outcomes, hospital satisfaction, and changes in quality of life; (3) patients who underwent transcatheter aortic valve replacement (TAVR) from January 2022 to January 2024, evaluating the one-year all-cause mortality rate, perioperative complications, and improvements in New York Heart Association (NYHA) classification. Results Between 2020 and 2024, a total of 583 874 individuals underwent echocardiographic screening. A total of 48 089 patients with aortic valve disease were identified, including 3 401 (7.1%) high-risk patients, 18 657 (38.8%) moderate-risk patients, and 26 031 (54.1%) low-risk patients. Among them, 2 417 patients were enrolled in whole-life cycle management. Patient satisfaction scores showed a yearly increase, rising from 73.89 points before 2020 to 93.74 points in 2024. The 1-year mortality rate in the TAVR cohort decreased to 5.3%, significantly lower than the 8.2% observed under early standard management between 2014 and 2019 (P<0.01). Conclusion Through process optimization and resource integration, the VHD whole-life cycle management model has demonstrated significant effectiveness in standardizing diagnostic and follow-up procedures, enhancing patient satisfaction and quality of life, and reducing mortality. These outcomes highlight its practical value for broader implementation in China.