Cardiac Valve Replacement Research Articles

Postoperative atrial fibrillation in patients on statins undergoing isolated cardiac valve surgery: a meta-analysis

Introduction: The efficacy of perioperative statin therapy in decreasing postoperative morbidity in patients undergoing valve replacements and repairs is unknown. The aim of our study was to determine whether or not the literature supports the hypothesis that statins decrease postoperative atrial fibrillation (AF), and hence improve short-term postoperative outcomes in patients undergoing isolated cardiac valve surgery.Method: We conducted a meta-analysis of studies on postoperative outcomes associated with statin therapy following isolated valve replacement or repair. The data was taken from published studies on valvular heart surgery patients. Participants were patients who underwent either isolated cardiac valve replacement or repair. Patients in the intervention group received statins prior to their surgery. Three databases were searched: Ovid Healthstar, 1966 to April 2012; Ovid Medline, 1946 to 31 May 2012; and Embase, 1974 to 30 May 2012. The meta-analysis was conducted using Review Manager® versio...

GW25-e0615 Value of C-reactive protein in predicting adverse prognosis after cardiac valve replacement surgery in patient with Chronic Rheumatic Valve Disease

GW25-e0615 Value of C-reactive protein in predicting adverse prognosis after cardiac valve replacement surgery in patient with Chronic Rheumatic Valve Disease

Effects of sevoflurane postconditioning on myocardial oxidative stress in patients undergoing cardiac valve replacement with cardiopulmonary bypass

Objective To evaluate the effects of sevoflurane postconditioning on myocardial oxidative stress in the patients undergoing cardiac valve replacement with cardiopulmonary bypass (CPB).Methods Fifty ASA physical status Ⅱ or Ⅲ patients (NYHA Ⅱ or Ⅲ) of both sexes,aged 36-59 yr,weighing 42-71 kg,with rheumatic heart disease undergoing cardiac valve replacement under CPB,were randomly divided into control group (group C,n =25) and sevoflurane postconditioning group (group S,n =25).In group S,4 ％ sevoflurane was infused for 10 min via the extracorporeal circulation machines starting from the time point immediately after aortic unclamping.Before aortic clamping and at 15 min,30 min,6 h,and 24 h after aortic unclamping (T1-5),blood samples were collected from the central vein for determination of the levels of cardiac troponin I (cTnI) in plasma.Myocardial specimens were taken from the left auricle before CPB and after termination of CPB for determination of malondialdehyde (MDA) content and superoxide dismutase (SOD) activity.The restoration of spontaneous heart beat,reperfusion arrhythmia scores,and requirement for vasoactive drugs were recorded.Results Compared with group C,MDA content was significantly decreased,and SOD activity was increased after termination of CPB,the plasma cTnI concentration was decreased at T2-5,the rate of restoration of spontaneous heart beat was increased,reperfusion arrhythmia scores were decreased,and the requirement for dopamine and nitroglycerin was reduced in group S.Conclusion Sevoflurane postconditioning provides myocardial protection by reducing myocardial oxidative stress injury in the patients undergoing cardiac valve replacement with CPB. Key words: Oxidative stress ; Myocardium ; Sevoflurane

The experiences of "difficult life" in heart valve replaced patients.

Background:Several reports, however, not comprehensive, have been presented about the experiences of patients with replaced heart-valve.Objectives:This study explores the experiences of the patients with heart valve replacement.Patients and Methods:A qualitative research with a content analysis approach was carried out on the patients with cardiac valve replacement during the year 2012 and 2013. A purposeful sampling using a semi-structured interview and open-ended questions (with the main question of "What problems did you have after the valve replacement?" followed by the exploratory questions) were performed until the data saturation. All interviews were recorded, then transcribed and typed. The data analysis was done according to Grancheim and Lundmen content analysis using the MAXQDA software.Results:Of 22 interviews taken from 13 participants, 430 codes were taken. Out of them, after deleting the similar items, 162 initial, 18 subcategory, and 5 subsidiary themes (problematic exposure with valve replacement, continuity of some difficulties, aggravation of life problems, insufficient support, and following a perceived care) were extracted. Based on the abstract and deep perception of the categories, the main theme of "difficult life" was explored.Conclusions:Aggravation and the continuity of some physical problems, and insufficient support after the valve replacement make the life difficult for the patients. Identification of these problems is necessary for planning and improvement of the patients' care, life quality, and survival through consultations, rehabilitation and education.

Effects of small dose of dopamine on renal blood flow in elderly patients undergoing cardiac valve replacement under cardiopulmonary bypass

Objective To evaluate the effects of small dose of dopamine on the renal blood flow in the elderly patients undergoing cardiac valve replacement under cardiopulmonary bypass (CPB).Methods Sixty elderly patients,of ASA physical status Ⅱ or Ⅲ,aged 65-74 yr,weighing 52-77 kg,scheduled for elective cardiac valve replacement under CPB,were randomized to receive either normal saline (group C,n =30) or dopamine (group D,n =30).After beginning of surgery,CPB was established routinely.In group D,dopamine was continuously infused for 20 min at a rate of 2 μg· kg-1 · min-1 starting from 10 min after the hearts were perfused with cardioplegic solution for the first time,while the equal volume of normal saline was given in group C.The left renal blood flow velocity was measured by transesophageal echocardiography and mean arterial pressure was recorded before and after dopamine infusion.Blood samples were obtained before surgery and at 24 h after surgery for determination of blood urea nitrogen concentrations.Results Blood urea nitrogen concentrations were significantly increased at 24 h after surgery than that before surgery in the two groups.There was no significant difference in mean arterial pressure and the left renal blood flow velocity before and after dopamine infusion between the two groups.Conclusion Small dose of dopamine (2 μg· kg-1· min-1) dose not increase the renal blood flow or improve the postoperative renal function in the elderly patients undergoing cardiac valve replacement under CPB. Key words: Dopamine ; Renal circulation ; Cardiopulmonary bypass ; Elder; Cardiac valve replacement

Guidelines for diagnosis and treatment of Hunter Syndrome for clinicians in Latin America.

This review aims to provide clinicians in Latin America with the most current information on the clinical aspects, diagnosis, and management of Hunter syndrome, a serious and progressive disease for which specific treatment is available. Hunter syndrome is a genetic disorder where iduronate-2-sulfatase (I2S), an enzyme that degrades glycosaminoglycans, is absent or deficient. Clinical manifestations vary widely in severity and involve multiple organs and tissues. An attenuated and a severe phenotype are recognized depending on the degree of cognitive impairment. Early diagnosis is vital for disease management. Clinical signs common to children with Hunter syndrome include inguinal hernia, frequent ear and respiratory infections, facial dysmorphisms, macrocephaly, bone dysplasia, short stature, sleep apnea, and behavior problems. Diagnosis is based on screening urinary glycosaminoglycans and confirmation by measuring I2S activity and analyzing I2S gene mutations. Idursulfase (recombinant I2S) (Elaprase(®), Shire) enzyme replacement therapy (ERT), designed to address the underlying enzyme deficiency, is approved treatment and improves walking capacity and respiratory function, and reduces spleen and liver size and urinary glycosaminoglycan levels. Additional measures, responding to the multi-organ manifestations, such as abdominal/inguinal hernia repair, carpal tunnel surgery, and cardiac valve replacement, should also be considered. Investigational treatment options such as intrathecal ERT are active areas of research, and bone marrow transplantation is in clinical practice. Communication among care providers, social workers, patients and families is essential to inform and guide their decisions, establish realistic expectations, and assess patients' responses.

Elimination of central sleep apnea by cardiac valve replacement: a continuous follow-up study in patients with rheumatic valvular heart disease

BackgroundRecent studies have suggested that cardiac surgery may affect sleep-disordered breathing (SDB) in chronic heart failure patients. However, the dynamic changes in sleep apnea and heart function after cardiac surgery and the mechanisms responsible for these changes remain unknown. MethodsPatients with rheumatic valvular heart disease (RVHD) and SDB were enrolled and followed up at three, six and 12months after cardiac valve replacement (CVR). Baseline and follow-up clinical data consisting of NYHA classification, 6min walk distance (6-MWD), medications, echocardiography, electrocardiography, chest X-ray, arterial blood gas, lung-to-finger circulation time (LFCT), and sleep data were collected and evaluated. ResultsTwenty-four central sleep apnea (CSA) patients and 15 obstructive sleep apnea (OSA) patients completed three follow-up assessments. Comparison of the baseline parameters between OSA patients and CSA patients showed that CSA patients had a worse baseline cardiac function assessed by higher NYHA class, shorter 6-MWD, larger left atrial diameter, longer LFCT, and enhanced chemosensitivity (higher pH and lower arterial carbon dioxide tension (PaCO2)). A continuous significant elevation in 6-MWD and left ventricular ejection fraction and decrease in NYHA class, plasma BNP, and left atrial diameter were found in both CSA and OSA patients. When comparing CSA and OSA patients, the CSA indices were remarkably reduced at month 3 post CVR and sustained throughout the trial, whereas there were no significant decreases in OSA index and hypopnea index. pH values and LFCT were markedly decreased and PaCO2 markedly increased in patients with CSA at the end of the third months following CVR. These changes were sustained until the end of the trial. ConclusionsCSA patients with RVHD had a worse baseline cardiac function, enhanced chemosensitivity and disordered hemodynamic as compared with OSA patients with RVHD. CSA were eliminated after CVR; however, there were no changes in OSA. The elimination of CSA, post CVR, is associated with the combined efficacies of improvement of cardiac function, normalized chemosensitivity, and stabilized hemodynamic.

Minimally invasive valve surgery.

Cardiac valve surgery is life saving for many patients. The advent of minimally invasive surgical techniques has historically allowed for improvement in both postoperative convalescence and important clinical outcomes. The development of minimally invasive cardiac valve repair and replacement surgery over the past decade is poised to revolutionize the care of cardiac valve patients. Here, we present a review of the history and current trends in minimally invasive aortic and mitral valve repair and replacement, including the development of sutureless bioprosthetic valves.

Body-temperature circadian rhythm in 67 patients after heart valve replacement surgery secondary to valvular heart disease

PurposePatient body temperature was monitored after cardiac valve replacement, in order to explore the characteristics of body-temperature circadian rhythm and the factors influencing that rhythm. MethodsA cohort of 67 patients who received cardiac valve replacement in a Fuzhou, Fujian province, China, general hospital underwent temperature measurements and analysis (by cosine curve) of their body-temperature circadian rhythm. A biological rhythm model was established through principal component analysis and evaluation of biological rhythm features. Multiple circadian parameters were included through linear regression analysis. ResultsPatients' temperature after cardiac valve replacement exhibited circadian characteristics (p < 0.05), among which the scores of temperature mesor, amplitude, and acrophase were respectively (37.61 ± 0.08), (0.10 ± 0.09), and −33 (–355, –119). Body-temperature rhythms were influenced by both gender and cardiopulmonary bypass time (p < 0.05). ConclusionAlthough some patients' circadian characteristics disappeared after cardiac valve replacement, circadian rhythms remained intact for most patients. Measures that were found to mitigate body-temperature circadian rhythm disruption included building a natural rhythm of light/darkness and decreasing cardiopulmonary bypass time.

Somatic GATA5 mutations in sporadic tetralogy of Fallot

Tetralogy of Fallot (TOF) is the most common form of cyanotic congenital heart disease, with high morbidity and mortality rates. Accumulating evidence has demonstrated that genetic defects play an important role in the pathogenesis of TOF. However, the molecular basis of TOF in the majority of patients remains to be determined. In the present study, sequence analysis of the coding exons and exon-intron boundaries of GATA5, a gene encoding a zinc finger‑containing transcriptional factor crucial for cardiogenesis, was performed on genomic DNA isolated from resected cardiac tissue and matched blood samples of 85 unrelated patients who underwent surgical repair of TOF. Genotyping was performed on the cardiac tissue and matched blood samples from 63 unrelated patients who underwent cardiac valve replacement due to rheumatic heart disease as well as the blood samples obtained from 200 unrelated healthy individuals. The functional effect of the mutations was evaluated by using a luciferase reporter assay system. As a result, the novel heterozygous GATA5 mutations, p.D203E and p.Y208X, were found in the cardiac tissues of two TOF patients, respectively. There were no mutations in the cardiac tissues obtained from 63 patients with rheumatic heart disease nor in the blood samples obtained from the 348 subjects. Functional analysis revealed that the GATA5 mutants were consistently associated with significantly decreased transcriptional activity compared with their wild-type counterpart. Thus, results of this study showed an association of somatic GATA5 mutations with TOF, providing further insight into the underlying molecular mechanism of TOF.

English

In this study, we investigated the correlation between CYP2C9 gene polymorphism and maintenance dose of Warfarin in 300 patients who were the Han population derived from the Affiliated Yan An Hospital of Kunming Medical University in Yunnan Province of China, subjected to the operation of cardiac valve replacement and Warfarin oral administration post operation from 2008 to 2009 by detecting the genotypes and Allele Frequency at the three candidate loci (CYP2C9*2，CYP2C9*3 and CYP2C9*c_65) of CYP2C9 gene from the blood samples. Polymerase chain reaction -restriction fragment length polymorphism (PCR-RFLP) assay and DNA sequencing were used to ascertain the genotypes and their corresponding distribution rate. The maintenance dose of Warfarin administered in anticoagulant therapy among the CYP2C9*3 genetypes found in our experiment showed: A/A wild type &gt; A/C heterozygote&gt;C/C homozygote, suggesting that patients with C mutation need the lowest maintenance dose of Warfarin among the three genotypes found in this study. Our results will shed a new light on the personalized medicine of Warfarin and provide basic and genetic experimental data and foundation for future studies with regard to multiple genes&rsquo; effect on Warfarin dorsage in anticogulantant therapy. Key words: Warfarin, maitenance dosage, CYP2C9, gene polymorphism, single nucleotide polymorphism (SNP), restriction fragment length polymorphism (RFLP), correlation.

Significantly Higher Rates of Gastrointestinal Bleeding and Thromboembolic Events With Left Ventricular Assist Devices

The risk of gastrointestinal (GI) bleeding (GIB) and thromboembolic events may increase with continuous-flow left ventricular assist devices (CF-LVADs). We aimed to characterize GIB and thromboembolic events that occurred in patients with CF-LVADs and compare them with patients receiving anticoagulation therapy. We performed a retrospective analysis of 159 patients who underwent CF-LVAD placement at 2 large academic medical centers (mean age, 55 ± 13 y). We identified and characterized episodes of GIB and thromboembolic events through chart review; data were collected from a time period of 292 ± 281 days. We compared the rates of GIB and thromboembolic events between patients who underwent CF-LVAD placement and a control group of 159 patients (mean age, 64 ± 15 y) who received a cardiac valve replacement and were discharged with anticoagulation therapy. Bleeding events occurred in 29 patients on CF-LVAD support (18%; 45 events total). Sixteen rebleeding events were identified among 10 patients (range, 1-3 rebleeding episodes/patient). There were 34 thrombotic events among 27 patients (17%). The most common source of bleeding was GI angiodysplastic lesions (n= 20; 44%). GIB and thromboembolic events were more common in patients on CF-LVAD support than controls; these included initial GIB (18% vs 4%, P<.001), rebleeding (6% vs none, P = .001), and thromboembolic events (17% vs 8%, P = .01). Patients with CF-LVADS receiving anticoagulants have a significantly higher risk of GIB and thromboembolic events than patients receiving anticoagulants after cardiac valve replacement surgery. GI angiodysplastic lesions are the most common source of bleeding.

Carcinoid heart disease

The carcinoid syndrome is usually evident when enterochromaffin (EC) cell-derived neuroendocrine tumors (carcinoids) metastasize to the liver. In addition to carcinoid symptomatology, about 40% of patients exhibit carcinoid heart disease (CHD) with fibrotic endocardial plaques and associated heart valve dysfunction. The mechanism behind CHD development is not fully understood, but serotonin (5-HT) is considered to be a major initiator of the fibrotic process. Most patients present with right-sided heart valve dysfunction since pulmonary and tricuspid valves lesions are the most common (N95%) cardiac pathology. Left-sided valvular involvement, and angina associated with coronary vasospasm occur in ~10% of subjects with CHD. Pathognomonic echocardiograpic features include immobility of valve leaflets and thickening and retraction of the cusps most commonly resulting in tricuspid valve regurgitation and pulmonary stenosis. Therapeutic options include cardioactive pharmacotherapy for heart failure and, in selected individuals, cardiac valve replacement. Previously valve replacement was reserved for advanced disease due to a perioperative mortality of N20% however in the last decade, technical advances as well as an earlier diagnosis have decreased surgical mortality to b10% and valve replacements are undertaken more frequently. A recent analysis of 200 cases demonstrated an increase in median survival from 1.5 years to 4.4 years in the last two decades. Although the improved prognosis might also reflect the increased use of surgical cytoreduction, hepatic metastatic ablative therapies and somatostatin analogs a robust correlation between diminution of circulating tumor products and an increased long-term survival in CHD has not been rigorously demonstrated. © 2008 Elsevier Ireland Ltd. All rights reserved.

Protective effect of intralipid on myocardium in extracorporeal circulation of cardiac valve replacement

Objective To investigate the effect of intralipid postconditioning on myocardial enzyme in patients receiving extracorporeal circulation of cardiac valve replacement.Methods Forty patients undergoing cardiac valve replacement were randomly divided into two groups.Patients in the experimental group were given intralipid(200 mL)immediately after aorta opening from the extracorporeal circulation machine,and those in the control group were given 200 mL normal saline in the same manner.The radial artery blood samples were collected at the beginning of the operation,0.5h,1h,2h,4h,and 24 h after aorta opening.The serum lactate dehydrogenase(LDH),creatine kinase(CK),creatine kinase isoenzyme(CK-MB),and cardiac troponin I(cTnI)were observed and the blood gas analysis was performed.The hemodynamic parameters,time of cardiopulmonary bypass,time of aorta block,time of operation,recovery of heartbeat,the dosage of dopamine,assisted ventilation time,ICU detention time,24 hurine amount,and 24 hour drainage amount after operation were all recorded in the two groups.Results There were no significant differences in hemodynamic parameters,dosage of dopamine used,spontaneous recovery of heartbeat,24 hurine amount,or 24 hour drainage amount between the two groups(P0.05).The postoperative levels of serum LDH,CK,CK-MB,and cTnI were significantly higher than those before operation in both groups(P0.05).Compared with the control group,the LDH level in the experimental group was significantly deceased 24 hafter aorta opening(P0.05);cTnI and CK levels were significantly decreased 4and 24 hafter aorta opening(P0.05);and CK-MB level were significantly decreased at 2,4,and 24 h after aorta opening(P 0.05).Conclusion Intralipid postconditioning by cardiopulmonary bypass can reduce the release of myocardial enzymes in patients receiving heart valve replacement surgery,thus alleviate myocardial ischemia-reperfusion injury.

English

Objective: To investigate whether the different concentrations of morphine after coronary perfusion have myocardial protection. Subjects and method: Forty-five patients undergoing heart valve replacement were randomly divided into three groups of 15 patients: group A (morphine 2 µmol/L in the cardioplegic solution), group B (morphine 4 µmol/L in the cardioplegic solution) and group C (no morphine in the cardioplegic solution). The three groups were monitored before induction (T1), five minutes before (T2) and five minutes after (T3) cardiopulmonary bypass (CPB), perioperative (T4) for haemodynamic parameters, two hours after CPB (T5) and 24 hours after CPB (T6). The postoperation incidence of severe ventricular arrhythmia and low cardiac output, CPB transit time, aortic cross-clamp time, defibrillation time, duration of ventilation and intensive care unit (ICU) and hospital stay were recorded. Results:The levels of cardiac troponin I (cTnI) at T5 and T6 in group A and group B were significantly lower than those in group C (p < 0.05), and at T6 in group B, were lower than those in group A (p < 0.05). The levels of CK-MB at T6 in group B were lower than those in group C (p < 0.05). The morphological changes in group A and group B were less than those in group C; and the least in group B. Conclusion:Morphine at concentrations of 2 µmol/L and 4 µmol/L after coronary perfusion on cardiac valve replacement with CPB has myocardial protection; 4 µmol/L of morphine provides more myocardial protection.

Recent Advances in Research on Human Aortic Valve Calcification

Aortic valve calcification can aggravate aortic stenoses, and it is a significant cause of sudden cardiac death. The increasing number of patients with age-related calcification is a problem in developed nations. However, the only treatment option currently available is highly invasive cardiac valve replacement. Therefore, clarification of the etiology of calcification is urgently needed to develop drug therapies and prevention methods. Recent studies have revealed that calcification is not a simple sedimentation of a mineral through a physicochemical phenomenon; various factors dynamically contribute to the mechanism. Further, we are finally beginning to understand the cellular origins of calcification, which had been unclear for a long time. Based on these findings that help to clarify potential drug targets, we expect to establish drug therapies that reduce the stress on patients. In this paper, I introduce the latest findings on cells that are most likely to contribute to calcification and on calcification-related factors that may lead to the development of drug therapies.

The expression of groups IIE and V phospholipase A2 is associated with an increased expression of osteogenic molecules in human calcified aortic valves.

Eicosanoids play various pathogenic roles in aortic valve calcification. Eicosanoids are derived from the arachidonic acid generated by phospholipase A2 (PLA2). We therefore sought to determine whether PLA2s are expressed in human aortic valves and, if so, whether the expression of PLA2s is related to the expression of osteogenic molecules in these tissues. Histological and gene expression analyses of 38 non-rheumatic aortic valves obtained at the time of cardiac valve replacement surgery were conducted. Moreover, gene expression analyses were performed using valve interstitial cells (VICs) obtained from human aortic valves. Among the PLA2s examined, the degree of immunoreactivity for PLA2s-IIE and -V was found to significantly correlate with the grade of calcification in the aortic valves. The degree of immunoreactivity and gene expression levels of PLA2s-IIE and -V significantly correlated with those of bone morphogenetic protein (BMP)-2, osteopontin and alkaline phosphatase (ALP). In addition, immunoreactivity for cyclooxygenase (COX)-1, COX-2 and 5-lipoxygenase, downstream enzymes of PLA2 in the arachidonic acid cascade, was co-localized with that for PLA2s-IIE and -V in cells expressing α-smooth muscle actin and macrophages expressing CD68. Furthermore, in the in vitro experiments using cultured VICs, the mRNA expression levels of BMP-2, osteopontin and ALP were suppressed by the inhibition of the expression of PLA2s-IIE or -V with specific siRNAs. The expression of PLA2s-IIE and -V correlates with the development of calcification as well as the expression of pro-osteogenic molecules in human aortic valves, and inhibiting the expression of PLA2s-IIE and -V suppresses the induction of osteogenic molecules in cultured cells. Therefore, PLA2s-IIE and -V may play a role in the pathogenesis of valve calcification.

Effect of Morphine and Fentanyl on Inflammatory Biomarkers in Rheumatic Heart Patients Undergoing Valve Replacement Surgery

Background: Cardiopulmonary bypass (CPB) is well known to be associated with a complex physiological response that is clinically manifested as a systemic inflammatory response syndrome. The aim of the study is to compare between the effect of morphine and fentanyl as part of a balanced anesthetic technique on the inflammatory reaction that occurs in cardiac valve replacement surgeries after CPB. Material and methods: Thirty patients undergoing cardiac surgery with cardiopulmonary bypass were randomized to receive either morphine or fentanyl as part of a standardized opioid-isoflurane anesthetic; Group 1 (15 patients received morphine, IV. Group 2 (15 patients received fentanyl. Hemodynamic data were recorded. Serum concentrations of interleukin [(IL)-6 and IL-10] and [(CD 11b, CD 11c, and CD 18] were measured. Results: There was a significant decrease in Heart Rate (HR) and Mean arterial pressure (MAP) in morphine group compared to fentanyl group. However, there were no significant differences between both groups in central venous pressure (CVP) and the incidence of intra operative arrhythmias. Serum levels of IL-6 and IL-8 concentrations increased in all patients after CPB. The increase in serum IL-6 levels was significantly attenuated in the morphine group compared to the fentanyl group at 3 and 24 hrs post CPB (P<0.05). The increase in IL-6 and IL- 10 concentrations was significantly attenuated in morphine group compared to the fentanyl group at 4hrs and 24hrs post-CPB (P<0.05). The reduction in adhesion molecules expression (CD 11b, CD 11c and CD 18) were significantly more in the morphine group than in the fentanyl group at 4 hrs and 24 hrs post-CPB (P<0.05). Conclusion: There were perturbations in the release of circulating cytokines, adhesions molecules and postoperative hyperthermia which attenuated by the use of morphine.

376例心脏瓣膜手术EuroSCORE高预测风险与低手术死亡率的关系

目的：分析376例心脏瓣膜置换手术EuroSCORE预测死亡风险和实际死亡率的变化趋势，评价心脏瓣膜置换手术对重症心脏瓣膜病患者的治疗价值。方法：回顾性分析本中心2007年3月至2012年12月376例心脏瓣膜置换手术的临床资料，对比全组病例欧洲心脏手术危险评估系统(EuroSCORE)平均值与手术死亡率的逐年变化趋势。同时将病例分为两组，符合重症心脏瓣膜病诊断标准的纳入重症组，其余患者纳入普通组。统计两组病例的EuroSCORE分值的平均分、手术死亡率、呼吸机辅助时间及并发症发生率(包括围术期心梗、脑卒中、恶性心律失常、急性肾功能衰竭及呼吸功能不全等)，进行组间比较。结果：全部病例EuroSCORE评分平均值从2007年的1.9上升到2012年的5.7，手术死亡率由2007年的3.1%下降至2012年的2.3%。EuroSCORE平均值逐年上升，而手术死亡率略有下降。重症组与普通组EuroSCORE平均值、手术死亡率、并发症率、呼吸机辅助时间等方面比较，差异均有统计学意义(p Objective: To analyze the relationship between EuroSCORE high prediction risk and low operation mortality in 376 cases of cardiac valve replacement, and evaluate the value of heart valve re-placement in the treatment of patients with severe heart valve disease. Methods: 376 cases of heart valve replacement form March 2007 to December 2012 were analyzed retrospectively in our center. The yearly change trends of the average value of the European heart operation risk assessment system (EuroSCORE) and operation mortality were contrasted. Then, the patients were divided into two groups. The severe group was divided with severe heart valve disease diagnosis standard, the remaining patients into common group. The average EuroSCORE, operation mortality, ventilation time, and the incidence of complications (including preoperative myocardial infarction, stroke, malignant arrhythmia, acute renal failure and respiratory insufficiency) of the two groups were compared between two groups. Results: The average EuroSCORE increased from 1.9 in 2007 to 5.7 in 2012; operation mortality decreased from 3.1% in 2007 to 2.3% in 2012. The average EuroSCORE was increasing year by year and the operation mortality declined slightly. The differences of the average EuroSCORE, operation mortality, ventilation time, and the incidence of complications between severe group and common group were statistically significant (p

Effects of pulmonary static inflation with different pressures on postoperative lung function in patients undergoing cardiac valve replacement with cardiopulmonary bypass

Objective To evaluate the effects of pulmonary static inflation with different pressures on postoperative lung function in patients undergoing cardiac valve replacement with cardiopulmonary bypass (CPB).Methods Sixty ASA Ⅱ or Ⅲ patients,aged 26-70 yr,weighing 47-78 kg,undergoing elective cardiac valve replacement with CPB,were randomly divided into 2 groups (n =30 each):pulmonary static inflation with 5 cm H2O group (group L) and with 10 cm H2O group (group H).In L and H groups,pulmonary static inflation was performed with the pressure maintained at 5 and 10 cm H2O,respectively,after stopping mechanical ventilation during CPB.Arterial blood samples were taken before skin incision and at 1,3 and 6 h after termination of CPB for blood gas analysis.The alveolar-arterial oxygen pressure difference (D(A-a)O2),respiratory index (RI) and oxy.genation index (OI) were calculated.The indwelling time of endotracheal tube after operation and duration of ICU stay were recorded.Results Compared with group L,D(A-a)O2 and RI were significantly decreased and OI was increased at 1,3 and 6 h after termination of CPB,the incidence of OI less than 300 mm Hg was decreased (P ＜ 0.05),and no significant change was found in the indwelling time of endotracheal tube after operation and duration of ICU stay in H group (P ＞ 0.05).Collusion Pulmonary static inflation with 10 cm H2O can better improve postoperative pulmonary diffusion function than with 5 cm H2O in patients undergoing cardiac valve replacement with CPB. Key words: Pressure; Extracorporeal circulation; Respiratory function tests; Pulmonary static inflation