Abstract
Objective:To analyze the success rates and prognosis of heart valvuloplasty and valve replacement for elderly patients, and to provide clinical evidence.Methods:A total of 1240 patients who received heart valve surgeries in our hospital from June 2004 to October 2014 were selected and retrospectively analyzed. They were divided into two groups based on age (60), and those older than 60 (Group B) suffered from rheumatic valvular heart disease and nonrheumatic valvular heart disease including degenerative valve disease. Mitral valve replacement (MVR), tricuspid valve replacement (TVR), aortic valve replacement (AVR), double valve replacement (DVR), mitral valvuloplasty (MVP) and tricuspid valvuloplasty (TVP) were performed by using bioprosthetic and mechanical valves. Before surgery, coronary angiography, coronary artery bypass grafting (CABG), left atrial thrombectomy, left atrial wall folding and radiofrequency ablation were conducted. For the patients younger than 60 (Group A) who had congenital heart disease, rheumatic valvular heart disease and valvular heart disease, MVR, AVR, DVR, MVP, TVP and closed cuspid commissurotomy were performed with bioprosthetic and mechanical valves. The two groups were then monitored.Results:The mortality rates of Group A and Group B were 2.7% (16 cases) and 3.1% (20 cases) respectively. They died mainly of malignant ventricular arrhythmias, multiple organ failure, left ventricular rupture, low cardiac output syndrome, acute renal failure, respiratory failure, upper gastrointestinal bleeding, mechanical valve failure and cerebrovascular accident. The two groups had significantly different application rates of bioprosthetic valve, times of auxiliary ventilation and hospitalization stay lengths (P<0.05), but left ventricular ejection fractions, left ventricular end-diastolic diameters (LVEDDs), mortality rates as well as times of aortic cross-clamping and cardiopulmonary bypass were similar (P>0.05). LVEDD, complicated coronary artery disease, CABG and grade of the New York Heart Association Functional Classification were independent risk factors for postoperative death.Conclusion:When heart valvuloplasty and valve replacement were performed for elderly patients, the success rate and prognosis could only be improved by optimizing preoperative preparation, shortening the times of cardiopulmonary bypass and aortic cross-clamping, and paying particular attention to myocardial protection and postoperative treatment.
Highlights
The elderly are more prone to hypertension, diabetes, obesity, renal failure and myocardial infarction due to lifestyle upgrade.[1]
Patients are vulnerable to brain, lung, liver and renal dysfunctions owing to long disease course,[15] and long-term cardiac injury induces arrhythmia and damages livers and lungs
If the patients who are planning to receive surgery for valvular heart disease are complicated with hypertension, diabetes and coronary artery disease, the incidence rates of postoperative complications and morality rates are bound to increase
Summary
The elderly are more prone to hypertension, diabetes, obesity, renal failure and myocardial infarction due to lifestyle upgrade.[1] The resulting weakened buffering capacity of vital organs, defensive ability and adaptability to surgery, as well as postoperative dysfunction of organs[2] induce nervous system diseases such as arterial embolism and cerebral hypoperfusion. As one of the common clinical complications,[3] valvular heart disease may even lead to death. Given organ dysfunction of elderly patients, the incidence of postoperative complications and mortality rate are often high.[4] In this study, we analyzed the success rates and prognosis of heart valvuloplasty and valve replacement for elderly patients
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