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find Keyword "瓣膜手术" 25 results
  • A wearable six-minute walk-based system to predict postoperative pulmonary complications after cardiac valve surgery: an exploratory study

    In recent years, wearable devices have seen a booming development, and the integration of wearable devices with clinical settings is an important direction in the development of wearable devices. The purpose of this study is to establish a prediction model for postoperative pulmonary complications (PPCs) by continuously monitoring respiratory physiological parameters of cardiac valve surgery patients during the preoperative 6-Minute Walk Test (6MWT) with a wearable device. By enrolling 53 patients with cardiac valve diseases in the Department of Cardiovascular Surgery, West China Hospital, Sichuan University, the grouping was based on the presence or absence of PPCs in the postoperative period. The 6MWT continuous respiratory physiological parameters collected by the SensEcho wearable device were analyzed, and the group differences in respiratory parameters and oxygen saturation parameters were calculated, and a prediction model was constructed. The results showed that continuous monitoring of respiratory physiological parameters in 6MWT using a wearable device had a better predictive trend for PPCs in cardiac valve surgery patients, providing a novel reference model for integrating wearable devices with the clinic.

    Release date:2023-12-21 03:53 Export PDF Favorites Scan
  • Combined Cardiac Valve Surgery and Coronary Artery Bypass Grafting: Report of 81 Cases

    Objective To retrospectively review the clinical experience and early surgical results of combined cardiac valve surgery and coronary artery bypass grafting (CABG). Methods From Jan. 2000 to Dec. 2005, combined valve surgery and CABG was performed in 81 patients. 37 patients were rheumatic heart disease with coronary stenosis, and 44 patients were coronary artery disease with valvular dysfunction. Single vessel disease was in 18 patients, two vessels disease in 9 and triple-vessel disease in 54. All the patients received sternotomy and combined valve surgery and CABG under cardiopulmonary bypass. Mitral valve repair and CABG were done in 26 patients. Valve replacement and CABG were done in 55 patients with 49 mechanical valves and 16 tissue valves. Four patients had left ventricular aneurysm resection concomitantly. The number of distal anastomosis was 3.12 5= 1.51 with 66 left internal mammary arteries bypassed to left anterior descending. Post-operative intra-aortic balloon pump was required in 4 cases for low cardiac output syndrome. Results Two patients died of low cardiac output syndrome with multiple organs failure. 79 patients had smooth recovery and discharged from hospital with improved heart function. 64 patients had completed follow-up with 5 late non cardiac related death in a mean follow-up period of 14.2 months. Conclusion Combined one stage valve surgery and CABG is effective with acceptable morbidity and mortality.

    Release date:2016-08-30 06:22 Export PDF Favorites Scan
  • Establishment of a Risk Prediction Model and Risk Score for Inhospital Mortality after Heart Valve Surgery

    Abstract: Objective To establish a risk prediction model and risk score for inhospital mortality in heart valve surgery patients, in order to promote its perioperative safety. Methods We collected records of 4 032 consecutive patients who underwent aortic valve replacement, mitral valve repair, mitral valve replacement, or aortic and mitral combination procedure in Changhai hospital from January 1,1998 to December 31,2008. Their average age was 45.90±13.60 years and included 1 876 (46.53%) males and 2 156 (53.57%) females. Based on the valve operated on, we divided the patients into three groups including mitral valve surgery group (n=1 910), aortic valve surgery group (n=724), and mitral plus aortic valve surgery group (n=1 398). The population was divided a 60% development sample (n=2 418) and a 40% validation sample (n=1 614). We identified potential risk factors, conducted univariate analysis and multifactor logistic regression to determine the independent risk factors and set up a risk model. The calibration and discrimination of the model were assessed by the HosmerLemeshow (H-L) test and [CM(159mm]the area under the receiver operating characteristic (ROC) curve,respectively. We finally produced a risk score according to the coefficient β and rank of variables in the logistic regression model. Results The general inhospital mortality of the whole group was 4.74% (191/4 032). The results of multifactor logistic regression analysis showed that eight variables including tricuspid valve incompetence with OR=1.33 and 95%CI 1.071 to 1.648, arotic valve stenosis with OR=1.34 and 95%CI 1.082 to 1.659, chronic lung disease with OR=2.11 and 95%CI 1.292 to 3.455, left ventricular ejection fraction with OR=1.55 and 95%CI 1.081 to 2.234, critical preoperative status with OR=2.69 and 95%CI 1.499 to 4.821, NYHA ⅢⅣ (New York Heart Association) with OR=2.75 and 95%CI 1.343 to 5641, concomitant coronary artery bypass graft surgery (CABG) with OR=3.02 and 95%CI 1.405 to 6.483, and serum creatinine just before surgery with OR=4.16 and 95%CI 1.979 to 8.766 were independently correlated with inhospital mortality. Our risk model showed good calibration and discriminative power for all the groups. P values of H-L test were all higher than 0.05 (development sample: χ2=1.615, P=0.830, validation sample: χ2=2.218, P=0.200, mitral valve surgery sample: χ2=5.175,P=0.470, aortic valve surgery sample: χ2=12.708, P=0.090, mitral plus aortic valve surgery sample: χ2=3.875, P=0.380), and the areas under the ROC curve were all larger than 0.70 (development sample: 0.757 with 95%CI 0.712 to 0.802, validation sample: 0.754 and 95%CI 0.701 to 0806; mitral valve surgery sample: 0.760 and 95%CI 0.706 to 0.813, aortic valve surgery sample: 0.803 and 95%CI 0.738 to 0.868, mitral plus aortic valve surgery sample: 0.727 and 95%CI 0.668 to 0.785). The risk score was successfully established: tricuspid valve regurgitation (mild:1 point, moderate: 2 points, severe:3 points), arotic valve stenosis (mild: 1 point, moderate: 2 points, severe: 3 points), chronic lung disease (3 points), left ventricular ejection fraction (40% to 50%: 2 points, 30% to 40%: 4 points, <30%: 6 points), critical preoperative status (3 points), NYHA IIIIV (4 points), concomitant CABG (4 points), and serum creatinine (>110 μmol/L: 5 points).Conclusion  Eight risk factors including tricuspid valve regurgitation are independent risk factors associated with inhospital mortality of heart valve surgery patients in China. The established risk model and risk score have good calibration and discrimination in predicting inhospital mortality of heart valve surgery patients.

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  • Risk Factors of Secondary Tricuspid Regurgitation: A Meta-Analysis

    Objective To analyze and explore the risk factors of secondary tricuspid regurgitation (TR) after left-sided valve surgery (left cardiac valve replacement or valvuloplasty) using meta-analysis, so as to provide evidence for clinical diagnosis and treatment of secondary TR. Methods We electronically searched databases including PubMed, MEDLINE, CBM, CNKI, VIP, for literature on the risk factors of secondary TR after left-sided valve surgery from 1995 to 2012. According to the inclusion and exclusion criteria, we screened literature, extracted data, and assessed methodological quality. Then, meta-analysis was performed using RevMan 5.0 software. Results A total of 6 case-control studies were included, involving 437 patients and 2 102 controls. The results of meta-analysis showed that, the risk factors of progressive exacerbation of secondary TR after left-sided valve surgery included preoperative atrial fibrillation (OR=3.90, 95%CI 3.00 to 5.07; adjusted OR=3.04, 95%CI 2.21 to 4.16), age (MD=5.36, 95%CI 3.49 to 7.23), huge left atrium (OR=5.17, 95%CI 3.12 to 8.57; adjusted OR=1.91, 95%CI 1.49 to 2.44) or left atrium diameter (MD=4.85, 95%CI 3.18 to 6.53), degradation of left heart function (OR=2.97, 95%CI 1.73 to 5.08), rheumatic pathological change (OR=3.06, 95%CI 1.66 to 4.68), preoperative TR no less than 2+ (OR=3.52, 95%CI 1.26 to 9.89), and mitral valve replacement (MVR) (OR=2.35, 95%CI 1.68 to 3.30). Sex (OR=1.54, 95%CI 0.94 to 2.52) and preoperative pulmonary arterial hypertension (OR=1.28, 95%CI 0.77 to 2.12) were not associated with secondary TR after left-sided valve surgery. Conclusion The risk factors of progressive exacerbation of secondary TR after left-sided valve surgery include preoperative atrial fibrillation, age, huge left atrium or left atrium diameter, degradation of left heart function, rheumatic pathological change, preoperative TR no less than 2+, and MVR. Understanding these risk factors helps us to improve the long-time effectiveness of preventing and treating TR after left-sided valve surgery.

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  • Surgical Treatment Experience of Emergency Surgery in Treating Rheumatic Valves Patients with Preoperative Ventricular Electrical Storm

    目的探讨成人风湿性心脏瓣膜病术前并发心室电风暴(恶性室性心动过速、心室颤动)行急诊手术的疗效及体会。 方法回顾性分析2004年10月至2014年10月我院成人心脏瓣膜入院后突发恶性室性心动过速、心室颤动的患者6例,其中男2例,女4例,年龄35.0~64.0岁,平均49.8岁。6例患者均为风湿性心脏瓣膜病,二尖瓣中重度狭窄并主动脉瓣及三尖瓣中重度关闭不全2例,二尖瓣中重度关闭不全并三尖瓣中重度关闭不全4例,恶性心律失常发作后立即予艾司洛尔等药物控制,病情基本稳定后急诊手术。其中,行双瓣膜置换+三尖瓣成形术2例,行二尖瓣置换+三尖瓣成形术4例。 结果无围术期患者死亡,术后无心功能显著恶化、无多脏器功能衰竭、无恶性室性心律失常。术后1~2周24 h动态心电图提示室性早搏大于1 000次的2例,室性早搏500~1 000次1例,小于500次的患者3例,短阵室性心动过速2次的患者2例,短阵室性心动过速3次的患者1例。所有6例患者均安全出院,随访6个月至10年,无患者死亡。 结论急诊外科手术联合β受体阻滞剂在治疗成人心脏瓣膜疾病术前突发的反复恶性室性心动过速、心室颤动安全有效。

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  • Analysis of factors affecting postoperative left ventricular function recovery in patients with valvular disease combined with heart failure with reduced ejection fraction

    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.

    Release date:2020-07-30 02:32 Export PDF Favorites Scan
  • 右侧乳缘下切口在再次瓣膜手术中的应用

    目的 探索经右侧乳缘下切口行再次瓣膜手术的临床应用效果。 方法 2012 年 12 月至 2017 年 3 月南京大学医学院附属鼓楼医院共 20 例患者经右侧乳缘下切口行再次瓣膜手术(右侧乳缘下切口组),其中男 11 例、女 9 例,平均年龄(51±8)岁。选取同时期 20 例经胸骨正中切口再次行二、三尖瓣手术患者(正中开胸组),其中男 13 例、女 7例,平均年龄(46±5)岁。右侧乳缘下切口组采用股动静脉插管,上腔静脉常规直角插管,第 4 肋间进胸,不断肋骨,常规升主动脉阻断或心室颤动下完成二、三尖瓣成形或置换、心房颤动消融和左房折叠等术式。 结果 正中开胸组有 3 例开胸时出现心脏破裂,而右侧乳缘下切口组只有 1 例游离下腔静脉时右房破裂。右侧乳缘下切口组开胸体外循环时间和术后住院时间均显著短于正中切口组[(55.0±22.0)min vs.(94.0±38.0)min,P<0.001;(12.3±3.7)dvs.(15.7±6.7)d,P=0.032]。右侧乳缘下切口组开胸时出血量和术后 24 h 引流量均显著少于正中开胸组[(92.0±37.0)ml vs.(342.0±157.0)ml,(202.0±117.0)ml vs.(567.0±254.0)ml,P均<0.001]。 结论 右侧乳缘下切口行再次心脏手术可完成除升主动脉和主动脉瓣操作之外的任何瓣膜和左房操作,具有手术创伤小、出血少、患者术后恢复快、美容效果好等优点。此外,对于外科医生而言,该技术手术难度较低,如果具备正中切口的解剖基础,完全可胜任此手术,但术中需注意肺和心肌保护。

    Release date:2018-03-05 03:32 Export PDF Favorites Scan
  • 老年患者二尖瓣置换同期行冠状动脉旁路移植术的临床分析

    目的 总结老年二尖瓣疾病合并冠心病患者心瓣膜置换术同期行冠状动脉旁路移植术(CABG)的经验,以提高临床效果。 方法 2002年7月至2004年7月我科共30例老年二尖瓣疾病患者二尖瓣置换术同期行CABG。年龄66.0±9.1岁(60~73岁), 4例为风湿性瓣膜病变,26例为二尖瓣瓣膜退行性病变。术前心功能分级(NYHA):Ⅰ级3例,Ⅱ级5例,Ⅲ级17例,Ⅳ级5例。共移植旁路血管71支,使用左侧乳内动脉24例,其余均为大隐静脉。置换机械瓣27例,置换生物瓣3例;行三尖瓣De Vega成形术17例。 结果 术后早期死亡1例(3.3%)。随访29例,平均随访时间13个月,心功能均有明显改善,Ⅰ级18例,Ⅱ级10例,Ⅲ级1例,可从事简单的运动及正常家务劳动,生活质量满意。 结论 老年二尖瓣疾病患者二尖瓣置换术同期行CABG的危险性较大,充分的术前准备,正确的手术方案,术中良好的心肌保护及严密的术后处理是手术成功的重要因素。

    Release date:2016-08-30 06:08 Export PDF Favorites Scan
  • Cryomaze ablation procedure for atrial fibrillation concomitant with valve surgery

    Objective To summarize safety and effectiveness of cryomaze ablation procedure concomitant with valve surgery. Methods We retrospectively investigated the clinical data of 62 patients (24 males and 38 females) with mean age of 49.4±14.2 years who underwent cryomaze ablation procedure concomitant with valve surgery in our hospital from August 2013 through July 2015. The heart rhythm of the patients after surgery was supervised by 12-leads electrical cardiogram respectively. Results The rate of sinus rhythm restored right after surgery was 98.4%. The rate of sinus rhythm restored at the time of discharge was 93.4%. The rate of sinus rhythm restored 3 months, 6 months, 12 months, 18 months after surgery was 90.2%, 87.3%, 85.0%, 83.3% respectively. The one-year post-operation rate of sinus rhythm restored for the group of right minimal invasive thoracoscopic assisted mitral valve surgery was 90.5%. Longer duration for atrial fibrillation (>7 years) was a risk factor for the reoccurrence of atrial fibrillation 1 year after surgery (P<0.05). Conclusion Cryomaze ablation procedure concomitant with valve surgery is quite effective in treatment of rheumatic valve disease and atrial fibrillation. This approach is associated with fewer complications, comparable atrial fibrillation reoccurrence for short-term follow-up.

    Release date:2017-04-24 03:51 Export PDF Favorites Scan
  • Perioperative results of cardiac valve surgery in patients with asymptomatic SARS-CoV-2 infection

    ObjectiveTo analyze the perioperative outcomes of cardiac valve surgery in patients with asymptomatic SARS-CoV-2 infection. MethodsThe perioperative clinical data of patients receiving heart valve replacement in the Department of Cardiovascular Surgery, the First Affiliated Hospital of University of Science and Technology of China from November 2022 to February 2023 were retrospectively analyzed. According to whether the patients were infected with SARS-CoV-2, they were divided into a non-infected group and an asymptomatic group. The perioperative data of the patients were compared between the two groups, and the effect of asymptomatic infection on the result of heart valve replacement surgery was analyzed. ResultsA total of 66 patients were enrolled including 36 males and 30 females with a mean age of 58.0±11.1 years. There were 51 patients in the non-infected group and 15 patients in the asymtomatic group. There were 2 patients of mitral valve replacement, 20 patients of aortic valve replacement, 1 patient of double valve replacement, 3 patients of aortic valve replacement with tricuspid valvoplasty, 22 patients of mitral valve replacement and tricuspid valvoplasty, 18 patients of double valve replacement and tricuspid valvoplasty. Asymptomatic infected patients received more emergency surgery than uninfected patients (26.7% vs. 0.0%, P<0.01). There was no statistical difference in the duration of extracorporeal circulation, aortic occlusion, mechanical ventilation time after the surgery, ICU stay, postoperative drainage volume, or postoperative complications between the two groups. ConclusionPerioperative results of cardiac valve surgery in patients with asymptomatic SARS-CoV-2 infection and non-infection are almost the same.

    Release date:2024-06-26 01:25 Export PDF Favorites Scan
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