Perioperative Management of Elderly Patients Undergoing Heart Valve Replacement_Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Authors：

 ZHOUZhong-xin , WANGGuo-xiang , JIANGBo , LIUJing-song , ZHANGZhong-ming

Department of Cardiothoracic Surgery, Affiliated Hospital of Xuzhou Medical College, Xuzhou 221002, Jiangsu, P. R. China;

Corresponding author：

ZHOUZhong-xin, Email: zzxgqh@163.com

Keywords：

Elderly patient; Valvular heart disease; Perioperative period

DOI：

10.7507/1007-4848.20140219

Video：

Export PDF Favorites Scan Get Citation

Abstract Full text Figures/Tables Video References Cited by

Objective To investigate clinical outcomes and summarize perioperative management experience of heart valve replacement (HVR)in elderly patients. Methods We retrospectively analyzed clinical data of 47 elderly patients undergoing HVR in Affiliated Hospital of Xuzhou Medical College from January 2011 to May 2014. There were 19 male and 28 female patients with their age of 60-79 years. There were 35 patients with rheumatic heart disease, 10 patients with degenerative valvular disease, and 2 patients with congenital bicuspid aortic valve. Preoperatively, there were 23 patients in NYHA functional class Ⅱ, 19 patients in class Ⅲ, and 5 patients in class Ⅳ. All the patients received HVR under cardiopulmonary bypass (CPB), and some patients received concomitant tricuspid valvuloplasty (TVP), left atrial thrombectomy or coronary artery bypass grafting (CABG). Postoperative mortality, morbidity and heart function improvement were evaluated. Results Twenty-seven patients received mitral valve replacement (MVR), 15 patients received aortic valve replacement (AVR), and 5 patients received MVR+AVR. Concomitantly, 4 patients received TVP, 3 patients received left atrial thrombectomy, and 6 patients received CABG. Operation time was 138-412 (196±52)minutes, CPB time was 48-301 (108±33)minutes, aortic cross-clamping time was 34-196 (87±21)minutes, and length of hospital stay was 12-31 (19±5)days. There was no intraoperative death, and 2 patients (4.3%)died postoperatively because of left ventricular failure and multiple organ dysfunction syndrome respectively. Twenty-three patients (51.1%)had postoperative complications including respiratory failure in 6 patients, pulmonary infection in 5 patients, arrhythmias in 5 patients, wound infection in 2 patients, pleural effusion in 2 patients, low cardiac output syndrome in 2 patients, and acute renal failure in 1 patient. Forty-five survival patients were followed up by telephone, online video and at the outpatient department for 1-32 months, and follow-up rate was 100%. There were 11 patients in NYHA functional classⅠ, 32 patients in class Ⅱ, and 2 patients in class Ⅲ. Conclusion According to clinical characteristics of elderly patients with valvular heart disease, meticulous surgical techniques and perioperative management can effectively reduce mortality and morbidity after HVR.

Citation： ZHOUZhong-xin, WANGGuo-xiang, JIANGBo, LIUJing-song, ZHANGZhong-ming. Perioperative Management of Elderly Patients Undergoing Heart Valve Replacement. Chinese Journal of Clinical Thoracic and Cardiovascular Surgery, 2014, 21(6): 766-768. doi: 10.7507/1007-4848.20140219 Copy

1.	史艺, 许建屏, 王强, 等.再次瓣膜置换217例临床分析.中华实用诊断与治疗杂志, 2011, 25(4):324-325.
2.	Beckmann E, Grau JB, Sainger R, et al. Insights into the use of biomarkers in calcific aortic valve disease. J Heart Valve Dis, 2010, 19(4):441-452.
3.	王齐敏, 陈道中, 陈良万, 等.老年心脏瓣膜置换术117例临床分析.福建医科大学学报, 2008, 42(4):372-373.
4.	De Arenaza DP, Pepper J, Lees B, et al. Preoperative 6-minute walk test adds prognostic information to Euroscore in patients undergoing aortic valve replacement. Heart, 2010, 96(2):113-117.
5.	陈一欢, 沈振亚, 余云生, 等.老年心脏瓣膜置换术27例临床观察.山东医药, 2011, 51(30):100-101.
6.	王晓明, 王亮, 韩志伟, 等.老年心脏瓣膜病变的外科治疗体会.中国心血管病研究, 2011, 9(5):343-345.
7.	袁忠祥, 杨迪成. 70岁以上瓣膜病患者心瓣膜置换术235例临床分析.中国胸心血管外科临床杂志, 2011, 18(1):72-74.
8.	梁克, 程可洛, 张万青, 等.老年患者心脏瓣膜置换术后低心排综合征相关因素的研究.中华实验外科杂志, 2013, 30(5):1060-1061.
9.	Halkos ME, Kilgo P, Lattouf OM, et al. The effect of diabetes mellitus on in-hospital and long-term outcomes after heart valve opera-tions. Ann Thorac Surg, 2010, 90(1):124-130.
10.	Fattouch K, Guccione F, Sampognaro R, et al. POINT:Efficacy of adding mitral valve restrictive annuloplasty to coronary artery bypass grafting in patients with moderate ischemic mitral valve regurgitation:a randomized trial. Thorac Cardiovasc Surg, 2009, 138(2):278-285.
11.	Benedetto U, Melina G, Roscitano A, et al. Does combined mitral valve surgery improve survival when compared to revascularization alone in patients with ischemic mitral regurgitation? A meta-analysis on 2479 patients. J Cardiovasc Med(Hagerstown), 2009, 10, (2):109-114.
12.	Kurlansky PA, Williarns DB, Trand EA, et al. The influence of coronary artery disease on quality of life after mechanical valve repla-cement. J Heart Valve Dis, 2004, 13(2):260-271.
13.	王德昌.老年患者心脏瓣膜置换术临床分析.中国实用医药, 2013, 8(4):85-86.
14.	丁凯, 周华富, 覃家锦, 等. 60岁以上瓣膜病患者的瓣膜置换术65例临床分析.重庆医学, 2010, 39(13):1687-1691.
15.	Emery RW, Krogh CC, Arom KV, et al. The St. Jude Medical cardiac valve prosthesis:a 25-year experience with single valve replace-ment. Ann Thorac Surg, 2005, 79(3):776-782.
16.	Choh JH. Preservation of anterior and posterior leaflet in mitral valve replacement with a tilting-disc valve. Ann Thorac Surg, 1997, 64(1):271-273.
17.	Nouette K, Richebé P, Calderon J, et al. Perioperative anticoagulation management for prosthetic heart valves. Ann Fr Anesth Reanim, 2005, 24(6):621-631.
18.	Bagur R, Webb JG, Nietlispach F, et al. Acute kidney injury follo-wing transcatheter aortic valve implantation:predictive factors, prognostic value, and comparison with surgical aortic valve replacement. Eur Heart J, 2010, 31(7):865-874.
19.	Natsuaki M, Itoh T, Tomita S, et al. Importance of preserving the mitral subvalvular apparatus in mitral valve replacement. Ann Thorac Surg, 1996, 61(2):585-590.
20.	孟毅, 董逸飞, 董书强, 等.老年心脏瓣膜手术早期死亡原因及相关因素分析.实用老年医学, 2011, 25(4):321-323.
21.	章岳峰, 赵琦峰, 胡超, 等.老年心脏瓣膜置换术患者的临床分析.中华老年医学杂志, 2013, 32(1):22-24.

1. 史艺, 许建屏, 王强, 等.再次瓣膜置换217例临床分析.中华实用诊断与治疗杂志, 2011, 25(4):324-325.
2. Beckmann E, Grau JB, Sainger R, et al. Insights into the use of biomarkers in calcific aortic valve disease. J Heart Valve Dis, 2010, 19(4):441-452.
3. 王齐敏, 陈道中, 陈良万, 等.老年心脏瓣膜置换术117例临床分析.福建医科大学学报, 2008, 42(4):372-373.
4. De Arenaza DP, Pepper J, Lees B, et al. Preoperative 6-minute walk test adds prognostic information to Euroscore in patients undergoing aortic valve replacement. Heart, 2010, 96(2):113-117.
5. 陈一欢, 沈振亚, 余云生, 等.老年心脏瓣膜置换术27例临床观察.山东医药, 2011, 51(30):100-101.
6. 王晓明, 王亮, 韩志伟, 等.老年心脏瓣膜病变的外科治疗体会.中国心血管病研究, 2011, 9(5):343-345.
7. 袁忠祥, 杨迪成. 70岁以上瓣膜病患者心瓣膜置换术235例临床分析.中国胸心血管外科临床杂志, 2011, 18(1):72-74.
8. 梁克, 程可洛, 张万青, 等.老年患者心脏瓣膜置换术后低心排综合征相关因素的研究.中华实验外科杂志, 2013, 30(5):1060-1061.
9. Halkos ME, Kilgo P, Lattouf OM, et al. The effect of diabetes mellitus on in-hospital and long-term outcomes after heart valve opera-tions. Ann Thorac Surg, 2010, 90(1):124-130.
10. Fattouch K, Guccione F, Sampognaro R, et al. POINT:Efficacy of adding mitral valve restrictive annuloplasty to coronary artery bypass grafting in patients with moderate ischemic mitral valve regurgitation:a randomized trial. Thorac Cardiovasc Surg, 2009, 138(2):278-285.
11. Benedetto U, Melina G, Roscitano A, et al. Does combined mitral valve surgery improve survival when compared to revascularization alone in patients with ischemic mitral regurgitation? A meta-analysis on 2479 patients. J Cardiovasc Med(Hagerstown), 2009, 10, (2):109-114.
12. Kurlansky PA, Williarns DB, Trand EA, et al. The influence of coronary artery disease on quality of life after mechanical valve repla-cement. J Heart Valve Dis, 2004, 13(2):260-271.
13. 王德昌.老年患者心脏瓣膜置换术临床分析.中国实用医药, 2013, 8(4):85-86.
14. 丁凯, 周华富, 覃家锦, 等. 60岁以上瓣膜病患者的瓣膜置换术65例临床分析.重庆医学, 2010, 39(13):1687-1691.
15. Emery RW, Krogh CC, Arom KV, et al. The St. Jude Medical cardiac valve prosthesis:a 25-year experience with single valve replace-ment. Ann Thorac Surg, 2005, 79(3):776-782.
16. Choh JH. Preservation of anterior and posterior leaflet in mitral valve replacement with a tilting-disc valve. Ann Thorac Surg, 1997, 64(1):271-273.
17. Nouette K, Richebé P, Calderon J, et al. Perioperative anticoagulation management for prosthetic heart valves. Ann Fr Anesth Reanim, 2005, 24(6):621-631.
18. Bagur R, Webb JG, Nietlispach F, et al. Acute kidney injury follo-wing transcatheter aortic valve implantation:predictive factors, prognostic value, and comparison with surgical aortic valve replacement. Eur Heart J, 2010, 31(7):865-874.
19. Natsuaki M, Itoh T, Tomita S, et al. Importance of preserving the mitral subvalvular apparatus in mitral valve replacement. Ann Thorac Surg, 1996, 61(2):585-590.
20. 孟毅, 董逸飞, 董书强, 等.老年心脏瓣膜手术早期死亡原因及相关因素分析.实用老年医学, 2011, 25(4):321-323.
21. 章岳峰, 赵琦峰, 胡超, 等.老年心脏瓣膜置换术患者的临床分析.中华老年医学杂志, 2013, 32(1):22-24.

Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Perioperative Management of Elderly Patients Undergoing Heart Valve Replacement

Abstract Full text Figures/Tables Video References Cited by

Previous Article

Next Article

Format

Content