Heart Valve Surgery Research Articles

Preoperative aortic annulus size assessment by transthoracic echocardiography compared to the size of surgically implanted aortic prostheses

Objectives: The aortic annulus diameter measured by transthoracic echocardiography yields lower values than by computed tomography, and echo-based selection of transcatheter aortic valve prosthesis size has been implied to result in more frequent paravalvular leakage. We investigated the relation of preoperative annulus diameter by echo with the ring size of the aortic prosthesis chosen by direct assessment during open-heart aortic valve replacement.Methods: Preoperative annulus diameter by echo (from parasternal long-axis cross-sections of the left ventricular outflow tract and aortic valve) and implanted prosthetic diameter (tissue annulus diameter, determined intraoperatively using a sizing instrument) were compared retrospectively in 285 consecutive patients undergoing open-heart aortic valve replacement.Results: A total of 285 prostheses (240 biologic and 45 mechanical) were implanted, with prosthetic diameter ranging between 19 and 27 mm. There was a significant linear correlation (P < 0.0001) with r = 0.51, between preoperative annulus diameter by echo (mean 21.8 ± 2.8 mm) and prosthetic diameter (22.9 ± 1.7 mm). Preoperative annulus diameter of patients receiving prostheses no. 21, 23 and 25 mm aortic prostheses (the most frequent prosthesis sizes) were significantly different (P < 0.001) from each other. On average, preoperative annulus diameter by echo underestimated prosthetic diameter by a bias of 1.07 mm.Conclusion: Our data confirm that preoperative echo assessment of the aortic valve may slightly underestimates the optimal surgical prosthesis diameter for the aortic valve annulus.

The "Heart Valve Clinic" Pathway for the Management of Frail Patients With Valvular Heart Disease: From "One for All" to "All for One".

Valvular heart disease (VHD) is frequently diagnosed in old patients with clinical evidence of heart failure. This elderly population typically presents a high prevalence of frailty and comorbidities, which are associated with increased operative risk for surgical and percutaneous procedures. Recently, the Euro Heart Survey reported a clear gap between treatment guidelines and their application in the "real world". A more realistic approach to the treatment of older VHD patients treatment, mostly if associated with heart failure, is advocated. A multidisciplinary approach, as obtained with the Heart Valve Clinic methodology (intended to put the patient in the "center" of the scene and the specialists "around him"), has been applied in a group of 79 patients, aged >70 years, with symptomatic VHD, divided in 2 groups according to their frailty status (58 robust and 21 frail). No in-hospital mortality and no difference in late mortality and complications were observed. Infections were more frequent (14.3 vs. 1.7 %; P = 0.02) in frail patients. In patients with postoperative complications, serum levels of interleukin 6 (67.6 vs. 49.6; P = 0.01) and of CAF (C-terminal agrin fragment) as sarcopenia marker (67.9 vs. 62.0; P = 0.04) were higher than that in uncomplicated patients. This study was designed to determine the outcomes of the multidimensional geriatric assessment in the management of older patients with heart failure eligible for heart valve surgery. Geriatric assessment and measurement of inflammatory and sarcopenia markers may represent valid tools for a more realistic evaluation of elderly patients with VHD.

Characteristics and prognosis of patients with significant tricuspid regurgitation

Severe tricuspid regurgitation (TR) usually remains asymptomatic for a long period, and the diagnosis is often delayed, at an advanced stage of right heart failure (RHF). Only a minority of patients are referred to surgery. We aim to describe the characteristics and prognosis according to aetiologies of patients with significant TR. Two hundred and eight consecutive patients with moderate-to-severe (grade III) or severe (grade IV) TR were included from echocardiography reports between 2013 and 2017. Median follow-up was 18(6–38) months. Patients (mean age 75 years, 46.6% males) were divided into 4 groups according to TR aetiology, group 1: primary TR (15.4%), group 2: TR secondary to left heart disease with a history of left heart valve surgery (24.5%), group 3: TR secondary to left heart disease with no history of left valvular surgery (26%) and group 4: idiopathic TR (34.1%). During follow-up, 61 patients (29%) experienced at least one decompensation of RHF requiring hospitalization. Only 11 patients (5.3%) underwent tricuspid valve surgery during follow-up with a perioperative mortality of 36%. The 4 years survival was much lower than the expected survival of age- and sex-matched individuals of the general population (56 ± 4% vs. 74%). After adjustment for outcome predictors, patients with idiopathic TR had a higher risk of mortality (adjusted HR = 1.83[1.05–3.21]; P = 0.034) compared to other groups. Moderate-to-severe and severe TR is associated with a high-risk of hospitalization for RHF and death at 4 years and a low rate of surgery. ( Fig. 1 Idiopathic TR is associated with worse outcome than other etiologies)

Genetic polymorphisms and dosing of vitamin K antagonist in Indian patients after heart valve surgery.

Vitamin K antagonists (VKAs), such as warfarin and acenocoumarol, exert their anti-coagulant effect by inhibiting the subunit 1 of vitamin K epoxide reductase complex (VKORC1). CYP2C9 is a hepatic drug-metabolizing enzyme in the CYP450 superfamily and is the primary metabolizing enzyme of warfarin. Three single nucleotide polymorphisms, two in the CYP2C9 gene, namely CYP2C9*2 and CYP2C9*3, and one in the VKORC1 gene (c.- 1639G > A, rs9923231), have been identified to reduce VKA metabolism and enhance their anti-coagulation effect. The purpose of this study is to evaluate the prevalence of CYP2C9 and VKORC1 polymorphism in Indians receiving VKA-based anti-coagulation after valve surgery and to evaluate the usefulness of genetic information in managing VKA-based anti-coagulation. In the current prospective observational study, 150 patients who underwent heart valve surgery and had stable INR were genotyped for VKORC1 (- 1639G > A), CYP2C9*2, and CYP2C9*3. The VKA dosage was estimated from published algorithms and compared to the clinically stabilized dosage. Out of 150 patients, 101 (67.33%) were on warfarin and 49 (32.66%) were on acenocoumarol. Majority of the patients, the 83 in warfarin group and the 40 in acenocoumarol group, had a wild CYP2C9 diplotype. The rest had a mutant (CYP2C9*2 or CYP2C9*3) diplotype. Similarly, 67 patients in the warfarin group and 35 patients in the acenocoumarol group had wild type (G/G) of VKORC1 genotype. The rest had a mutant (G/A or A/A) VKORC1 genotype. In the warfarin group, based on the genotype, 51.5% of the patients were extensive or normal metabolizers, and 47.4% of the patients were intermediate metabolizers of VKAs. In the acenocoumarol group, 61.2% of the patients were extensive or normal metabolizers, and 38.8% of the patients were intermediate metabolizers. Individually, alleles of VKORC1 (- 1639G > A), CYP2C9*2, and CYP2C9*3 had mean dosage reduction effect on VKA dosage, which co-related to the clinically stabilized dosages (P < 0.0001). Among the VKORC1 (- 1639G > A) cohort, the reduction in warfarin mean weekly dosage was 13.48mg as compared to the wild-type category (P < 0.0001) and similarly, the reduction in the mean weekly acenocoumarol dose was 6.07mg (P < 0.03) as compared to the wild type after adjusting for age, gender, and body mass index. Single nucleotide polymorphism in the CYP2C9 gene and in the VKORC1 gene is present in nearly 40% of Indian patients. VKORC1 (- 1639G > A), CYP2C9*2, and CYP2C9*3 genotypes have significant dosage-lowering effects on VKA-based anti-coagulation therapy. The trend in estimated dosages of VKAs co-related to that of observed the clinically stabilized dosage in the cohort. The pharmacogenomic calculators used in this study tend to overestimate the VKA dosages as compared to clinical dosage due to the limitations in the algorithms and in our study. A new algorithm based on a larger dataset capturing the vast genetic variability across the Indian population and relevant clinical factors could provide better results.

MON-610 Different Effects of Subclinical Hypothyroidism on Long-Term Outcomes of Patients Underwent CABG and Heart Valve Surgery

We performed this study to investigate whether subclinical hypothyroidism (SCH) is associated with long-term cardiovascular outcome after coronary artery bypass grafting (CABG) or heart valve surgery (HVS). All-cause mortality and cardiovascular (CV) mortality, and cardiovascular events were retrospectively reviewed in 395 euthyroid and 66 SCH patients who underwent CABG. We also analyzed cardiovascular outcomes in 87 euthyroid and 17 SCH patients who underwent HVS. During a mean follow-up period of 7.5 ± 3.9 years, there were 159 incidents of all-cause deaths, 26 CV deaths, 124 major cardiovascular adverse events (MACE), 11 myocardial infarctions, 1 unstable angina, 70 strokes, 23 hospitalizations due to heart failure, 101 atrial fibrillation events, and 33 coronary revascularizations. The incidence rate of all-cause mortality after CABG was significantly higher in patients with SCH (n=31, 47.0%) than in euthyroid patients (n=105, 26.6%), with a hazard ratio (HR) of 1.721 (95% confidence interval [CI] 1.068, 2.772; p=0.026) after adjustment with age, sex, underlying diseases, LV dysfunction and emergency operation. Interestingly, low T3 level in euthyroid patients (TSH 0.0-4.0mIU/L) who underwent CABG significantly increased all-cause, CV mortality and MACE in contrast to those of HVS. Moreover, both low T4 and high TSH level in euthyroid patients (TSH 0.0-4.0mIU/L) were not related to increased all-cause mortality, CV mortality and MACE in both CABG and HVS groups. In conclusion, insufficient thyroid status including low T3 in euthyroid and subclinical hypothyroid is associated with a long-term mortality in patients who underwent CABG, but the effects were not observed in HVS suggesting the importance of preoperative thyroid hormonal status in patients with ischemic heart disease. More RCTs should be needed to confirm whether normalization of thyroid function before CABG operation is helpful for the better postoperative outcome.

Echocardiography Parameters Predicting Postoperative Atrial Fibrillation: their Influence on Early left Atrial Remodelling and Right Ventricular Function after Heart Valve Surgery

Echocardiography Parameters Predicting Postoperative Atrial Fibrillation: their Influence on Early left Atrial Remodelling and Right Ventricular Function after Heart Valve Surgery

Effect of early, individualised and intensified follow-up after open heart valve surgery on unplanned cardiac hospital readmissions and all-cause mortality

BackgroundUnplanned readmissions after heart valve surgery are common, and constitute a significant burden for the patient and the health care system. The objective was to investigate the effect of individualised follow-up after open heart valve surgery on a composite endpoint of first unplanned cardiac hospital readmission or all-cause mortality within 180 days of discharge. MethodsThe study is a prospective cohort study comparing the composite endpoint in patients undergoing early, individualised and intensified follow-up after heart valve surgery with a propensity matched historical control group. A total of 308 consecutive patients were enrolled in the prospective cohort study, 980 consecutive patients comprised the control group. The propensity matched group consisted of n = 300 (intervention) and n = 580 (controls).Time to first event was analysed using uni- and multivariable Cox proportional hazard analysis. Kaplan-Meier survival curves were constructed to assess the probability of survival without readmission. ResultsAfter 180 days, the proportion of patients experiencing the composite endpoint was significantly lower in the intervention group compared with the controls for the overall, unmatched population (23% vs. 38%; HR 0.55; 95% CI, 0.42 to 0.73; P < 0.001). The effect did not change in the propensity matched population (HR 0.57; 95% CI 0.43;0.75, P < 0.001). The difference was related to reduction in readmission rates, whereas death rates were similar in intervention and control group (1.6% vs. 1.8%). ConclusionAn intervention consisting of early, individualised and intensified follow-up after open heart valve surgery reduced the risk of a composite endpoint of first, unplanned cardiac hospital readmission or all-cause mortality within 180 days.

The effect of “patient blood management” training on the number of red blood cell transfusions in patients undergoing cardiac surgery: a 5-year retrospective study

Aim: Red blood cell transfusion may be inevitable in cardiac surgery due to both blood loss and hemodilution secondary to cardiopulmonary bypass. Transfusion strategies may change over time owing to technological advances. The aim of this study was to evaluate the effect of the patient blood management education applied to healthcare staff on the number of red blood cell transfusions and clinical outcomes of the patients undergoing cardiac surgery.Material and Methods: Patients were included to the study if they had undergone coronary artery bypass grafting and/or heart valve surgery at the cardiovascular surgery clinic of tertiary training and research hospital during the five-year period between January 1, 2013 and December 31, 2017. Age, sex, number of RBC transfusions, Euroscore II, type of surgery, duration of mechanical ventilation, length of intensive care unit (ICU) stay, length of hospital stay, and in-hospital mortality of the patients were recorded. As the intervention, a patient blood management course was held for anesthesia and intensive care unit staff the department of cardiovascular surgery in December 2015. Patient blood management program was started as of 1st January of 2016 during perioperative period in cardiac surgery patients. Patients were divided into two groups as those undergoing cardiac surgery before January 2016 (Group I, the control group) and those having the surgery after January 2016 (Group II, the intervention group). The groups were compared in terms of sex, age, Euroscore II, duration of mechanical ventilation at intensive care unit, length of stay at intensive care unit and hospital, and in-hospital mortality.Results: A total of 691 patients were found to meet inclusion criteria. The patients in Group I and Group II were statistically similar in age, sex, and Euroscore II. Mean number of RBC transfusions were 3.55 ± 1.49 in Group I and 2.77 ± 1.64 in Group II (p&amp;lt;0.001). The duration of mechanical ventilation in Group I (6.56 ± 1.18 days) was significantly longer than that in Group II (5.93 ± 14.1 days), (p&amp;lt;0.001). There was no statistically significant difference between the groups in terms of length at ICU and hospital (p=0.255 and p=0.823, respectively). The mortality rate was 3.0% in Group I and 3.5% in Group II, where the difference was not statistically significant (p=0.736). Conclusion: The training of healthcare personnel about current “patient blood management” protocols was associated with reduced number of perioperative RBC transfusions and partially improved clinical outcomes in patients undergoing cardiac surgery.

Postoperative Plasma Mitochondrial DNA and Cytokine Profiles of Elderly Patients Undergoing Minimally Invasive Aortic Valve Replacement.

Mitochondrial DNA (mtDNA) is gaining increasing interest as a marker of cellular damage and could also act as an inflammatory mediator in cardiopulmonary bypass induced postoperative inflammatory response. Although minimally invasive heart valve surgery reportedly reduces inflammation, the mtDNA and cytokine profile in this context remains unclear. Here, we report a prospective series of 40 elderly patients with aortic stenosis who underwent bioprosthetic aortic valve replacement (AVR) through upper ministernotomy with either a sutureless (n = 20) or a conventional (n = 20) valve. Primary end points included serial plasma levels of mtDNA (T1: at baseline; T2: 4 hours after surgery; and T3: 24s hour after surgery), cytokines (interleukin-6 [IL-6], tumor necrosis factor-α [TNF-α]), and myocardial necrosis biomarkers (MNBs), whereas secondary end points included clinical and echocardiographic data. Significant increases in the postoperative plasma levels (T2) of mtDNA, cytokines, and MNBs were observed in all patients. The postoperative plasma levels of mtDNA, TNF-α, and MNBs showed no significant differences between the treatment groups, although there was a trend toward lower levels in the sutureless group. The decreases in aortic cross-clamp and cardiopulmonary bypass times seen in the sutureless group were associated with significant lower postoperative levels (T2 and T3) of IL-6. AVR through upper ministernotomy was associated with a significant increase in postoperative plasma levels of mtDNA and cytokines. There was no difference in the mtDNA levels between the sutureless and conventional valve groups, suggesting a similar level of inflammation in both groups. However, the shorter operation time observed in the sutureless valve group was associated with significantly lower postoperative levels of IL-6, indicating potential clinical benefits.

Postoperative atrial fibrillation is associated with delayed early rehabilitation after heart valve surgery: a multicenter study.

Postoperative atrial fibrillation (POAF) is a common complication after cardiac surgery. The aim of this multicenter study was to determine the relationship between POAF and patients' progress in early rehabilitation after heart valve surgery. We enrolled 302 patients (mean age, 69±10 years) who had undergone heart valve surgery. POAF was monitored using continuous electrocardiogram telemetry, and the Short Physical Performance Battery (SPPB) was used to assess lower-extremity function before surgery and at the time of discharge. Progress in early rehabilitation was evaluated by the duration from the surgery to independent walking. We determined factors associated delayed early rehabilitation and evaluated the interplay of POAF and delayed early rehabilitation in increasing the risk of decline in lower-extremity function from preoperatively to hospital discharge. Multivariate analysis determined POAF to be independent predictors of delayed early rehabilitation after heart valve surgery (OR: 3.906, P = .01). The association between delayed early rehabilitation and decline in lower extremity function was stronger in patients with POAF (OR: 2.73, P = .041) than in those without (OR: 2.22, P = .052). POAF was clinical predictors of delayed early rehabilitation in patients undergoing heart valve surgery. The combination of POAF with delayed early rehabilitation conferred a high risk of decline in lower-extremity function during hospitalization.

Impact of postoperative acute kidney failure in long-term survival after heart valve surgery.

We investigated the impact of acute kidney failure after a heart valve procedure among patients with or without chronic kidney disease (CKD). All patients who had undergone a surgical valve procedure between 2005 and 2017 at our institution were divided into 2 groups depending on whether they had previous history of CKD (estimated glomerular filtration rate <60 ml/min/1.73 m2) or not. Homogeneous groups were obtained by propensity score matching. Long-term mortality was compared between the 2 groups and according to the occurrence of postoperative acute kidney failure. Level of significance was set at P-value <0.008 for multiple comparison tests. From the 3907 patients included to this study, 1476 (37.78%) had previous history of CKD. After adjusting for propensity score 1:1, patients with preoperative impaired renal function were at a higher risk of acute kidney failure (26.83% vs 10.16%, P < 0.001) and postoperative mortality (8.48% vs 5.17%, P = 0.001). In the follow-up, they had a poorer survival at 1, 5 and 10 years as compared to patients with normal renal function (88% vs 91.95%, 78.29% vs 81.11% and 56.13% vs 66.29%, respectively; P < 0.001). Patients without postoperative kidney failure had similar survival whether they had preoperative CKD or not [hazard ratio (HR) 1.16, 99.2% confidence interval (CI) 0.87-2.52; P = 0.142]. As compared to patients with postoperative preserved renal function, those with postoperative kidney failure had a higher long-term mortality either if they had previous kidney disease or not [(HR 2.18, 99.2% CI 1.75-2.72; P < 0.001) and (HR 1.48, 99.2% CI 1.33-1.65; P < 0.001), respectively]. Preoperative CKD was the strongest predictor of acute kidney failure (odds ratio 4.45; 95% CI 3.59-5.53; P < 0.001). Patients with CKD are at higher risk of postoperative adverse events and have poorer long-term outcomes. Postoperative acute kidney failure increases long-term mortality.

Tissue Engineering in Cardiovascular Surgery: Evolution and Contemporary Condition of the Problem

The “ideal” graft for forming outflow ways is a big issue in reconstructive heart valve surgery. For today, this question is a field of interest especially in pediatric cardiac surgery, because the existing prosthesis are exposed to aggressive degenerative processes due to metabolic features, and also do not have the growth potential. Therefore, repetitive graft reimplantation gradually increases risk of surgery and greatly reduce the quality of patient’s life. Tissue engineering is a new perspective approach in surgery of congenital and heart valve diseases, which may help overcome limitations of existing and provide the new opportunities for surgical correction. This review highlights current trends in development of tissue-engineered heart valves and grafts, and existing limitations and potential solutions are discussed.

INCIDENCE AND RISK FACTORS FOR IMPLANTATION OF A CARDIAC ELECTRONIC DEVICE FOLLOWING MITRAL OR AORTIC VALVE SURGERY

The risk factors for post-operative conduction disturbances after heart valve surgery requiring cardiac implantable electronic devices (CIED) remains poorly characterized. We conducted a retrospective cohort study using a mandatory statewide discharge database, New York's Statewide Planning and

Symptom Clusters and Quality of Life Changes according to Recovery Period of Patients with Heart Valve Surgery

Symptom Clusters and Quality of Life Changes according to Recovery Period of Patients with Heart Valve Surgery

N-terminal of the prohormone brain natriuretic peptide is a predictor of hemodynamic instability in valve disease.

Aim: The usefulness of N-terminal of the prohormone brain natriuretic peptide (NT-proBNP) as a predictor of perioperative hemodynamic instability is not fully elucidated. Methods: This prospective study was conducted on a group of 455 patients undergoing elective heart valve surgery. The primary endpoint at the 30-day follow-up was postoperative hemodynamic instability. The secondary end point was death from all causes in patients with postoperative hemodynamic instability. Results: The postoperative hemodynamic instability occurred in 85 patients. At multivariate analysis NT-proBNP, New York Heart Association classes and glomerular filtration rate remained independent predictors of the primary endpoint. Age and NT-proBNP were associated with an increased risk of death. Conclusion: The preoperative NT-proBNP can be used to predict a postoperative hemodynamic instability as well as death in the group of patients with postoperative hemodynamic instability.

Reduction of plasma angiopoietin-like 2 after cardiac surgery is related to tissue inflammation and senescence status of patients

ObjectivesA strong relationship between high circulating angiopoietin-like 2 (ANGPTL2) levels, a proinflammatory adipokine, and cardiovascular diseases has been reported. Our objective was to determine whether plasma ANGPTL2 and high-sensitivity C-reactive protein (hs-CRP) levels change postoperatively in patients who underwent heart valve surgery and/or coronary artery bypass grafting. We hypothesized that a corrective cardiac surgery would decrease ANGPTL2 levels. MethodsIn 47 prospectively recruited patients who underwent coronary artery bypass grafting (n = 16), valve replacement (n = 16), or both (n = 15), we measured plasma ANGPTL2 and hs-CRP levels preoperatively, at 24 hours, at 3 to 5 days (hospital discharge), and at 30 to 90 days (follow-up) after surgery. Mediastinal adipose tissue and distal fragments of the left internal mammary artery (IMA) were harvested during surgery and mRNA expression of inflammatory and senescence markers was assessed using real-time quantitative polymerase chain reaction. ResultsANGPTL2 and hs-CRP levels were elevated 24 hours after surgery and then returned to baseline levels. We noted, however, a dichotomy among patients: compared with baseline, plasma ANGPTL2 levels either significantly decreased (n = 21/47) or increased (n = 26/47) after surgery. In contrast, hs-CRP levels were identical between groups (P = .997). Patients in the increased group were older (P = .002) with a higher systolic blood pressure (P = .038) at baseline. Moreover, changes in ANGPTL2 levels (ΔANGPTL2 = final minus initial levels) positively correlated with mRNA expression of tumor necrosis factor α and interleukin 8 in mediastinal adipose tissue and IMA (P < .05) and with the senescence-associated marker cyclin-dependent kinase inhibitor 1 in IMA (P = .009). ConclusionsIn younger patients with lower levels of tissue inflammation and arterial senescence load, ANGPTL2, but not hs-CRP levels decreased after cardiac surgery, suggesting that circulating ANGPTL2 reflects tissue inflammation and senescence.

Measuring HRQoL following heart valve surgery: the HeartQoL questionnaire is a valid and reliable core heart disease instrument.

Patient-reported health-related quality of life is a complementary healthcare outcome and important when assessing treatment efficacy. Using COSMIN methodological recommendations, this study evaluates the validity and reliability of a core heart disease-specific health-related quality of life questionnaire, the HeartQoL questionnaire (Danish version) in a sample of patients following heart valve surgery. This project involved a cross-sectional validity study and a test-retest reliability study. Eligible patients completed the HeartQoL, the SF-36 health survey questionnaire, and the Hospital Anxiety and Depression Scale following heart valve surgery. Construct validity was tested using a priori hypotheses. Internal consistency reliability was assessed with Cronbach's alpha. An independent sample of patients participated in the test-retest study and reproducibility was determined with relative [intra-class correlation coefficient (ICC)] and absolute reliability [standard error of measurement (SEM) and smallest detectable change (SDC)]. Internal consistency was high with Cronbach's alpha ≥ 0.87. ICC was 0.86-0.92. SEM ranged from 0.17 to 0.26 points and SDC ranged from 0.5 to 0.7 points. Construct validity was confirmed with 87% of all a priori hypotheses for predicted variables. The HeartQoL questionnaire demonstrates acceptable construct validity, internal consistency, and test-retest reproducibility in patients following heart valve surgery. Future studies should focus on assessing the responsiveness of the HeartQoL questionnaire over time and following heart valve surgery.

Prognostic factors for heart valve surgery outcomes in Dr Sardjito General Hospital Yogyakarta, Indonesia

Heart valve disease is a serious health probem due its significant effect on mortality.Surgical intervention plays an importan roleinthe management of moderate to the severe valvular heart disease. The evaluation of the patientoutcomes has been widely accepted as one of the important steps to improve the quality of patient care.Recognition of post operative complications might significantly affect the patient quality of life.Therefore, the identification of prognostic factors and morbidity of heart surgery patients can provide valuable insights on improving the quality of patient care.This study aimedto investigat the prognostic factors for heart valve surgery outcomes in Dr. Sardjito General Hospital, Yogyakarta, Indonesia. This study was conducted using data ofpatient’s medical records who underwent heart valve surgeryincluded morbidities and their prognostic factors.The data were analyzed using Chi-square test and logistic regression with significance level of 0.05. During 2010 to 2014, 82 patients underwent heart valve surgeries at the hospital. The kidney disorders and heart failure were significantly associated with the patient morbidity (p 0.05). Multivariate analysis showed that the heart failure is the most significant factor of morbidity. The risk of New York Heart Association (NYHA) class 3 patients were 7.18 times compared with NYHA class 2 patients. In conclusion, the heart failure is the most significant factor for the morbidityof heart valve surgery followed by the kidney disorders at the Dr. Sardjito General Hospital.

Mitral Valve Surgery in a Patient 50 Years after a Pneumonectomy

Background Patients who survive long after pneumonectomy may develop heart valve disease. The consecutive operations can be complex because of the challenging anatomical conditions and the limited physiologic reserves of the patient. Case Presentation The subject is a 78-year-old patient who underwent a left-sided pneumonectomy for a metastasized testicular tumor 50 years ago. At 32 and 37 years postpneumonectomy, mitral regurgitation was manifested, and valve repair was performed. Bioprosthetic mitral valve replacement and tricuspid valve reconstruction became necessary 44 years postpneumonectomy. The patient was fully recovered. Conclusion In case of relevant heart valve disease after pneumonectomies, heart valve surgeries are feasible.

Risk scores in heart valve surgery

Risk scores in heart valve surgery