Perioperative Management of Elderly Patients Undergoing Heart Valve Replacement_Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Authors：

 ZHOUZhong-xin , WANGGuo-xiang , JIANGBo , LIUJing-song , ZHANGZhong-ming

Department of Cardiothoracic Surgery, Affiliated Hospital of Xuzhou Medical College, Xuzhou 221002, Jiangsu, P. R. China;

Corresponding?author：

ZHOUZhong-xin, Email: zzxgqh@163.com

Keywords：

Elderly patient; Valvular heart disease; Perioperative period

DOI：

10.7507/1007-4848.20140219

Video：

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Objective To investigate clinical outcomes and summarize perioperative management experience of heart valve replacement (HVR)in elderly patients. Methods We 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. Results Twenty-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. Conclusion According to clinical characteristics of elderly patients with valvular heart disease, meticulous surgical techniques and perioperative management can effectively reduce mortality and morbidity after HVR.

Citation： ZHOUZhong-xin, WANGGuo-xiang, JIANGBo, LIUJing-song, ZHANGZhong-ming. Perioperative Management of Elderly Patients Undergoing Heart Valve Replacement. Chinese Journal of Clinical Thoracic and Cardiovascular Surgery, 2014, 21(6): 766-768. doi: 10.7507/1007-4848.20140219 Copy

1.	史藝, 許建屏, 王強, 等.再次瓣膜置換217例臨床分析.中華實用診斷與治療雜志, 2011, 25(4):324-325.
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4.	De Arenaza DP, Pepper J, Lees B, et al. Preoperative 6-minute walk test adds prognostic information to Euroscore in patients undergoing aortic valve replacement. Heart, 2010, 96(2):113-117.
5.	陳一歡, 沈振亞, 余云生, 等.老年心臟瓣膜置換術27例臨床觀察.山東醫藥, 2011, 51(30):100-101.
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8.	梁克, 程可洛, 張萬青, 等.老年患者心臟瓣膜置換術后低心排綜合征相關因素的研究.中華實驗外科雜志, 2013, 30(5):1060-1061.
9.	Halkos ME, Kilgo P, Lattouf OM, et al. The effect of diabetes mellitus on in-hospital and long-term outcomes after heart valve opera-tions. Ann Thorac Surg, 2010, 90(1):124-130.
10.	Fattouch K, Guccione F, Sampognaro R, et al. POINT:Efficacy of adding mitral valve restrictive annuloplasty to coronary artery bypass grafting in patients with moderate ischemic mitral valve regurgitation:a randomized trial. Thorac Cardiovasc Surg, 2009, 138(2):278-285.
11.	Benedetto U, Melina G, Roscitano A, et al. Does combined mitral valve surgery improve survival when compared to revascularization alone in patients with ischemic mitral regurgitation? A meta-analysis on 2479 patients. J Cardiovasc Med(Hagerstown), 2009, 10, (2):109-114.
12.	Kurlansky PA, Williarns DB, Trand EA, et al. The influence of coronary artery disease on quality of life after mechanical valve repla-cement. J Heart Valve Dis, 2004, 13(2):260-271.
13.	王德昌.老年患者心臟瓣膜置換術臨床分析.中國實用醫藥, 2013, 8(4):85-86.
14.	丁凱, 周華富, 覃家錦, 等. 60歲以上瓣膜病患者的瓣膜置換術65例臨床分析.重慶醫學, 2010, 39(13):1687-1691.
15.	Emery RW, Krogh CC, Arom KV, et al. The St. Jude Medical cardiac valve prosthesis:a 25-year experience with single valve replace-ment. Ann Thorac Surg, 2005, 79(3):776-782.
16.	Choh JH. Preservation of anterior and posterior leaflet in mitral valve replacement with a tilting-disc valve. Ann Thorac Surg, 1997, 64(1):271-273.
17.	Nouette K, Richebé P, Calderon J, et al. Perioperative anticoagulation management for prosthetic heart valves. Ann Fr Anesth Reanim, 2005, 24(6):621-631.
18.	Bagur R, Webb JG, Nietlispach F, et al. Acute kidney injury follo-wing transcatheter aortic valve implantation:predictive factors, prognostic value, and comparison with surgical aortic valve replacement. Eur Heart J, 2010, 31(7):865-874.
19.	Natsuaki M, Itoh T, Tomita S, et al. Importance of preserving the mitral subvalvular apparatus in mitral valve replacement. Ann Thorac Surg, 1996, 61(2):585-590.
20.	孟毅, 董逸飛, 董書強, 等.老年心臟瓣膜手術早期死亡原因及相關因素分析.實用老年醫學, 2011, 25(4):321-323.
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1. 史藝, 許建屏, 王強, 等.再次瓣膜置換217例臨床分析.中華實用診斷與治療雜志, 2011, 25(4):324-325.
2. Beckmann E, Grau JB, Sainger R, et al. Insights into the use of biomarkers in calcific aortic valve disease. J Heart Valve Dis, 2010, 19(4):441-452.
3. 王齊敏, 陳道中, 陳良萬, 等.老年心臟瓣膜置換術117例臨床分析.福建醫科大學學報, 2008, 42(4):372-373.
4. De Arenaza DP, Pepper J, Lees B, et al. Preoperative 6-minute walk test adds prognostic information to Euroscore in patients undergoing aortic valve replacement. Heart, 2010, 96(2):113-117.
5. 陳一歡, 沈振亞, 余云生, 等.老年心臟瓣膜置換術27例臨床觀察.山東醫藥, 2011, 51(30):100-101.
6. 王曉明, 王亮, 韓志偉, 等.老年心臟瓣膜病變的外科治療體會.中國心血管病研究, 2011, 9(5):343-345.
7. 袁忠祥, 楊迪成. 70歲以上瓣膜病患者心瓣膜置換術235例臨床分析.中國胸心血管外科臨床雜志, 2011, 18(1):72-74.
8. 梁克, 程可洛, 張萬青, 等.老年患者心臟瓣膜置換術后低心排綜合征相關因素的研究.中華實驗外科雜志, 2013, 30(5):1060-1061.
9. Halkos ME, Kilgo P, Lattouf OM, et al. The effect of diabetes mellitus on in-hospital and long-term outcomes after heart valve opera-tions. Ann Thorac Surg, 2010, 90(1):124-130.
10. Fattouch K, Guccione F, Sampognaro R, et al. POINT:Efficacy of adding mitral valve restrictive annuloplasty to coronary artery bypass grafting in patients with moderate ischemic mitral valve regurgitation:a randomized trial. Thorac Cardiovasc Surg, 2009, 138(2):278-285.
11. Benedetto U, Melina G, Roscitano A, et al. Does combined mitral valve surgery improve survival when compared to revascularization alone in patients with ischemic mitral regurgitation? A meta-analysis on 2479 patients. J Cardiovasc Med(Hagerstown), 2009, 10, (2):109-114.
12. Kurlansky PA, Williarns DB, Trand EA, et al. The influence of coronary artery disease on quality of life after mechanical valve repla-cement. J Heart Valve Dis, 2004, 13(2):260-271.
13. 王德昌.老年患者心臟瓣膜置換術臨床分析.中國實用醫藥, 2013, 8(4):85-86.
14. 丁凱, 周華富, 覃家錦, 等. 60歲以上瓣膜病患者的瓣膜置換術65例臨床分析.重慶醫學, 2010, 39(13):1687-1691.
15. Emery RW, Krogh CC, Arom KV, et al. The St. Jude Medical cardiac valve prosthesis:a 25-year experience with single valve replace-ment. Ann Thorac Surg, 2005, 79(3):776-782.
16. Choh JH. Preservation of anterior and posterior leaflet in mitral valve replacement with a tilting-disc valve. Ann Thorac Surg, 1997, 64(1):271-273.
17. Nouette K, Richebé P, Calderon J, et al. Perioperative anticoagulation management for prosthetic heart valves. Ann Fr Anesth Reanim, 2005, 24(6):621-631.
18. Bagur R, Webb JG, Nietlispach F, et al. Acute kidney injury follo-wing transcatheter aortic valve implantation:predictive factors, prognostic value, and comparison with surgical aortic valve replacement. Eur Heart J, 2010, 31(7):865-874.
19. Natsuaki M, Itoh T, Tomita S, et al. Importance of preserving the mitral subvalvular apparatus in mitral valve replacement. Ann Thorac Surg, 1996, 61(2):585-590.
20. 孟毅, 董逸飛, 董書強, 等.老年心臟瓣膜手術早期死亡原因及相關因素分析.實用老年醫學, 2011, 25(4):321-323.
21. 章岳峰, 趙琦峰, 胡超, 等.老年心臟瓣膜置換術患者的臨床分析.中華老年醫學雜志, 2013, 32(1):22-24.

Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Perioperative Management of Elderly Patients Undergoing Heart Valve Replacement

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