Objective To investigate the effects of tight blood glucose control on the shortterm prognosis of the patients after heart valve replacement, in order to improve treatment effectiveness and lower postoperative complications. Methods A total of 240 patients including 150 males and 90 females underwent mitral valve replacement or mitral and aortic valve replacement were enrolled in this study from January 2007 to December 2008 at the cardiac surgery department of Renmin hospital of Wuhan university. The age of these patients ranged from 19 to 65 years old with an average age of 53.33 years. According to insulin administration time and blood glucose control level, they were randomly separated into two groups. In the experimental group, there were 121 patients who received continuous insulin infusion to maintain postoperative glucose level between 4.4 and 6.1 mmol/L, while 119 patients in the control group received insulin infusion when their glucose level went higher than 11.1 mmol/L to control the level between 6.1 and 11.1 mmol/L. Then the postoperative wound infection, malignant arrhythmia rate, the assisted ventilation time, intensive care unit(ICU) stay time and count of neutrophils were compared and analyzed. Results There was no hospitalized death in both groups. The rate of wound infection（3.31% vs.10.08%, χ2=4.430,P=0.035）, the assisted ventilation time（9.02±2.73 h vs. 10.01±3.58 h, t=2.280,P=0.024）, time for count of leukocytes to decrease to the normal level（11.04±3.16 d vs. 12.05±3.76 d, t=2.168,P=0.031）, average hospitalization time（13.49±3.81 d vs. 14.51±4.02 d,t=2.017,P=0.045）, and count of neutrophils on the third day（0.82±0.04 vs. 0.84±0.05, t=2.644,P=0.009） in the experimental group were significantly lower or shorter than those in the control group. But there was no significant difference between both groups in ICU stay time and the rate of malignant arrhythmia. Conclusion Tight blood glucose control can lower the rate of postoperative wound infection, shorten the assisted ventilation time and hospitalization time, and reduce the usage of antibiotics in patients after heart valve replacement. Accordingly, it can enhance the curative effect, reduce overall medical expenses, and improve prognosis.
Objective To compare the efficacy of 6-epsilon-aminocaproic acid （EACA） with aprotinin on reducing postoperative bleeding in cardiac valve replacement procedures, and to investigate its influence on the possible thromboembolism and the renal function. Methods Seventy-nine patients who underwent cardiac valve replacement were randomly divided into two groups： EACA group （n = 39） and aprotinin group （n = 40）, which were given EACA and aprotinin separately in operations. The volumes of drainage to body surface area （BSA）, blood transfusion were recorded during 24 h after operations. The concentrations of serum D-dimer and α2-antiplasmin （a2- AP） were measured before, during operation and at 72h post-operatively. The serum creatinine levels before operation and at the 72 h after operation were also measured. Results The volume ratio of drainage to BSA in EACA group was significantly higher than that in the aprotinin group at 24 h after operation （P = 0. 019）. However, there was no significant difference in the volumes of blood transfusion between two groups （P〉0. 05）. Also no statistical difference in the concentrations of D-dimer and a2-AP were found between two groups whether preoperatively or at 72h post-operatively （P= 0. 960,0. 485）, D-dimer and a2-AP of the aprotinin group were higher than those in the EACA group after aortic off-clamping （P = 0. 001,0. 000）. There was no statistically difference of △CrCl72 in both groups （P〉0. 05）. No patient with thrombosis or thromboembolism was detected in two groups.Conclusion Although the efficacy of EACA in reducing postoperative bleeding in cardiac valve replacement can not compare favorably with that of aprotinin, the blood transfusion volume would not increase when EACA is used introoperatively. Proper usage of EACA will not cause thrombosis and renal damage.
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...
Abstract: Objective To summarize the experiences of treatment for prosthetic valve endocarditis (PVE), paying special emphasis on some interrelated conceptions of PVE, its microbiology, diagnosis, prevention and treatment. Methods From September 1979 to September 2009, 33 patients diagnosed to have PVE were treated in our department. There were 17 males and 16 females. Their age ranged from 19 to 57 years old with an average age of 34 years. The incidence of PVE was 1.48% （33/2 236）including 1.03%（16/1 551）, 3.00%（7/233）, 2.28%（10/438）, and 0% of PVE in mitral valve replacement (MVR), aortic valve replacement (AVR), double valve replacement (DVR), tricuspid valve replacement (TVR), respectively. Pure medical treatment (Penicillin or Vancomycin with other broadspectrum antibiotics, Fluconazole and Amphotericin) was performed on 22 patients. Combined medical and surgical treatment was performed in 11 patients. The patients underwent operation after adequate antibiotics treatment and general condition improvement. The infective tissue and vegetation were completely debrided after the infective prosthetic valve was removed. Before the new valve was transplanted, paravalvular tissue was cleaned with antibiotics, iodine solution and normal saline. Results Hospital death occurred in 19 patients (86.36%) and only 3 patients (13.64%) recovered in the group with pure medical treatment. The main reasons for death were infective shock and cardiac failure in 9 patients, and cerebral complications including embolism, bleeding and multipleorgan failure in 10 patients. For the group with combined medical and surgical treatment, 10 patients (90.91%) survived and only one patient (9.09%) died of multipleorgan failure. Follow-up was done in 13 patients for 6 months to 15 years averaging 41 months. During the follow-up, only one patient was reoperated because of the paravalvular leak eight year later. There was no PVE recurrence in all the rest patients. Conclusion Compared with pure medical treatment, combined medical and surgical treatment is a better solution for PVE.
Objective To investigate the perioperative changes of serum brain natriuretic peptide (BNP) concentrations in patients undergoing cardiac valve replacement. Methods There were 20 patients admitted to the study, the serum BNP concentrations were measured before cardiac surgery, 24 hours, 7days, 14 days, and 30 days after operation. The preoperative NYHA cardiac function and the left ventricular ejection fraction(LVEF) were measured by echocardiogram. Results The preoperative BNP level was the baseline, it elevated markedly and acutely to a peak value 24 hours after operation ( P =0.003), then the BNP decreased 7 days later, but was still higher than the concentration before operation ( P =0.015), 14 days later it reached to the concentration before operation, 30 days later it was mild lower than preoperative BNP level, but there was no significant difference. There was a positive correlation between NYHA and BNP ( r =0.69, P lt;0.05), but no correlation between LVEF and BNP( r =0.29, P gt;0 05). Conclusion The preoperative serum BNP concentration can reflect the preoperative cardiac function in patients undergoing cardiac valve replacement, the high BNP level indicates the poor cardiac function. The BNP sharply elevated in the early time after operation, then gradually decreased in the late phase postoperation.
ObjectiveTo summarize the efficacy of different anticoagulation methods during perioperative period of non-cardiac surgery after cardiac valve replacement and to compare the postoperative bleeding-related complications and embolization-related complications.MethodsRetrospective analysis of clinical data of 56 patients who underwent non-cardiac surgery after cardiac valve replacement in our hospital from January 2016 to January 2018 was conducted. There were 27 males and 29 females, aged 19-75 (53.56±13.94) years. According to different anticoagulation methods during perioperative period, the patients were divided into a bridging group (32 patients) and a non-bridging group (24 patients). The postoperative hospital stay, the number of patients needing postoperative blood transfusions, bleeding-related complications and embolization-related complications were compared between the two groups. According to the patient’s perioperative embolization risk, each group of patients were divided into a high-risk subgroup, middle-risk subgroup, and low-risk subgroup, and the bleeding-related complications and embolization-related complications in each subgroup were compared.ResultsThe postoperative hospital stay in the bridging group was significantly longer than that in the non-bridging group (P<0.05), but there was no significant difference in the number of patients needing postoperative blood transfusions, overall bleeding-related complications and embolization-related complications between the two groups (P>0.05). Subgroup analysis was performed according to the degree of embolization risk in the perioperative period. The incidence of bleeding-related complications of the non-bridging group in the high-risk subgroup was significantly higher than that in the high-risk subgroup of the bridging group (P<0.05). The incidence of bleeding-related complications in the bridging group was similar to that of embolization-related complications, while the rate of bleeding-related complications in the non-bridging group was 7 times higher than that of embolization-related complications.ConclusionBridging anticoagulation increases the length of postoperative hospital stay, but for patients with high risk factors for embolization, it is more beneficial than continuing oral warfarin during the perioperative period. The incidence of bleeding-related complications associated with continued warfarin therapy is significantly higher than that of embolization-related complications, and hemostatic drugs can be given necessarily.
Objective To report the experiences of cardiac valve operation in children. Methods Cardiac valve operations were performed in 87 children who were 58 male and 19 female between age of 4 to 14 years (mean 10.2 years). Of the 87 patients, 36 underwent mitral valve replacement, 13 aortic valve replacement, 6 mitral and aortic valve replacement, 13 aortic valvuloplasty, and 19 mitral valvuloplasty. Associated cardiac lesions were simultaneously managed. Results Postoperative complications included low car...
Abstract: Objective To investigate the in vivo effective orifice area (EOA) and whether prosthesispatient mismatch (PPM) is going to happen after 19mm St.Jude Regent valves replacement were performed. Methods Twentythree patients with valvular heart diseases were divided into 2 groups according to aortic annular diameter. 19mm St. Jude Regent valves were replaced in aortic valve place (Regent valve group), and 21mm other doubleleaflet mechanical valves were replaced in aortic place (other valves group). All of the operations were accomplished under cardiopulmonary bypass in West China Hospital. All of the patients were followed up in 3 to 6 months after their surgery processes. Color Doppler echocardiography was used to measure the hemodynamic parameters in their followup. Then left ventricular mass (LV mass), EOA and effective orifice area index (EOAI) etc. were calculated and compared by using SPSS 12.0. Results No cardiac episodes were detected during the perioperative period and 36 months after operation. LVmass reduced in 36 months after operation in both groups. No statistical significance of EOA, EOAI and LVmass reduction were detected between the two groups. Conclusions (1)The EOA and in vivo hemodynamic effects of 19mm Regent valve are similar to 21mm other double leaflet mechanical valve. (2)It is safe to use 19mm Regent valve in those patients whose aortic annular diameter are small and need double valve replacement. Using 19mm Regent valve will not cause short time cardiac episodes and PPM. (3)More further works should be done to make sure what is the standard of PPM in Chinese people, such as enlarging the patients number and prolonging the followup time. (4) Further clinical and followup works should be done to make St.Jude Regent valve’s feature out.
Objective To investigate the effect of early postoperative enteral nutrition support on the balance of free amino acid spectrum in plasma for patients with cardiac valve replacement during perioperative period. Methods (Forty-seven) patients undergoing cardiac valve replacement were divided into two groups randomly, the routine diet group and the Nutrison Fibre group. The levels of free amino acids in plasma were measured with pre-column derivatization of high-performance liquid chromatography. Results During perioperative period most free amino acids in plasma decreased significantly in the routine diet group (Plt;0.05). Despite some free amino acids in plasma decreased significantly in the Nutrison Fibre group(Plt;0.05), all free amino acids in plasma returned to (Pgt;05) or were higher than the preoperative levels in the postoperative sixth day (Plt;0.05). At the same postoperative points, most free amino acids in plasma in the Nutrison Fibre group were higher than that of the routine diet group (Plt;0.05). Conclusions The levels of free amino acids in plasma decrease significantly in patients with cardiac valve replacement after operation. Early postoperative Nutrison Fibre enteral nutrition support is helpful for keeping the balance of free amino acids in plasma for patients with cardiac valve replacement.
Abstract： Objective To investigate the effect of salvianolate on myocardium against ischemiareperfusion injury (IRI) in valve replacement with cardiopulmonary bypass (CPB), its outcome and mechanism, and the applicability and safety of salvianolate as a protection agent for CPB central muscles. Methods Thirty patients undergoing cardiac valve replacement were randomly divided into two groups by lot. In the control group, there were 15 patients including 5 males and 10 females, while in the 15 patients in the trial group, 7 were male and 8 were female. Salvianolate of 200 mg was given to the patients in the trial group intravenously. Hemodynamic parameters, blood gas analysis results, recovery of heartbeat, the dosage of dopamine used, and assisted ventilation time were recorded for both groups before aorta clamping, 2 h, 8 h, and 24 h after aorta declamping. Besides, ICU detention time, the amount of urine in 24 hours, and the amount of drainage in 24 hours after operation were also recorded. Blood samples were taken to determine serum cardial troponin I(cTnI), creatine kinase MB isoenzyme (CK-MB), malondialdehude (MDA), and superoxide dismutase (SOD) in both groups respectively at different times including after the induction of anesthesia, aorta opening, termination of CPB, end of operation, and one day after operation. Results There was no significant difference in hemodynamic parameters, the dosage of dopamine used, spontaneous recovery of heartbeat, and the amount of urine in 24 hours and drainage after operation for 24 hours between the two groups (Pgt;0.05). The rate of ventricular rhythm, blood lactic acid level, the time of assisted ventilation and ICU detention time for the trial group were significantly lower than those for the control group (Plt;0.05), while partial pressure of oxygen in artery(PaO2) was significantly lower in the trial group 8 h after aorta declamping (Plt;0.05). The levels of serum CK-MB, cTnI, and MDA after operation for both groups were higher than those before operation; and those levels for the trial group were significantly lower than the control group at various time points (Plt;0.05). The concentration of SOD decreased after operation in both groups (Plt;0.05), and it was higher in the trial group than the control group at different time points. The decrease of SOD level in the trial group was less than that in the control group. Conclusion Salvianolate can protect myocardium from ischemiareperfusion injury in cardiac valve replacement with CPB effectively, through promoting the activity of antioxidative enzymes and eliminating oxygen free radicals. Patients can be treated with salvianolate for antimyocardial ischemia reperfusion injury.