The surgical treatment strategy and perioperative management of patients with heart valve disease complicated with severe chronic heart failure_Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Authors：

GUO Qiannan ¹ , LI Tian ² , ZHU Guizhi ¹ , KAN-PAATIB BARNABO NAMPOUKIME ¹ , PAN Youmin ¹ , LI Jun ¹ ,  WANG Haihao ¹

1. Department of Cardiovascular Surgery, Tongji Hospital Affiliated to Tongji Medical College of Huazhong University of Science and Technology, Wuhan, 430030, P.R.China;
2. Department of Operating Theatre, Tongji Hospital Affiliated to Tongji Medical College of Huazhong University of Science and Technology, Wuhan, 430030, P.R.China;

Corresponding author：

WANG Haihao, Email: hhwang@tjh.tjmu.edu.cn

Keywords：

Valvular heart disease; severe chronic heart failure; surgical treatment; perioperative management

DOI：

10.7507/1007-4848.201902012

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Objective To summarize the individualized selection of surgical treatment strategies and the key points of perioperative management for patients with heart valve disease complicated with severe chronic heart failure.Methods The clinical characteristics of 5 male patients with valvular heart disease complicated with severe chronic heart failure (CHF) were analyzed retrospectively from June 2017 to October 2018 in Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, with an average age of 60.21 years.Results Five patients were given angiotensin receptor and neprilysin inhibitor (ARNI)-based anti-heart failure treatment after admission. The operation mode of these patients was decided to be valve replacement under cardiopulmonary bypass after individualized evaluation of patients’ improving symptoms. Three patients were treated with intra-aortic balloon pump (IABP) and continuous renal replacement therapy (CRRT) early after operation to assist patients in improving cardiac function. Five patients recovered oral anti-heart failure after awakening. All patients were discharged smoothly 2 weeks after operation.Conclusion Individualized evaluation is needed for the choice of operation timing and mode, standardized preoperative treatment for heart failure, shortening the aortic blocking time during cardiopulmonary bypass, and early application of left ventricular adjuvant drugs or instruments are all important measures to help patients recover smoothly.

Citation： GUO Qiannan, LI Tian, ZHU Guizhi, KAN-PAATIB BARNABO NAMPOUKIME, PAN Youmin, LI Jun, WANG Haihao. The surgical treatment strategy and perioperative management of patients with heart valve disease complicated with severe chronic heart failure. Chinese Journal of Clinical Thoracic and Cardiovascular Surgery, 2019, 26(10): 1004-1007. doi: 10.7507/1007-4848.201902012 Copy

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1. Rheumatic fever and rheumatic heart disease. World Health Organ Tech Rep Ser 2004; 923: 1-122, back cover.
2. Iung B, Vahanian A. Epidemiology of acquired valvular heart disease. Can J Cardiol, 2014, 30(9): 962-970.
3. Rostagno C. Heart valve disease in elderly. World J Cardiol, 2019, 11(2): 71-83.
4. Haude M. Management of valvular heart disease : ESC/EACTS guidelines 2017. Herz, 2017, 42(8): 715-720.
5. Shang X, Xiao S, Dong N, et al. Assessing right ventricular function in pulmonary hypertension patients and the correlation with the New York Heart Association (NYHA) classification. Oncotarget, 2017, 8(52): 90421-90429.
6. Yancy CW, Jessup M, Bozkurt B, et al. 2017 ACC/AHA/HFSAfocused update of the 2013 ACCF/AHA guideline for the management of heart failure: A report of the American College of Cardiology/American Heart Association Task Force on clinical practice guidelines and the Heart Failure Society of America. J Card Fail, 2017, 23(8): 628-651.
7. Kamperidis V, Delgado V, van Mieghem NM, et al. Diagnosis and management of aortic valve stenosis in patients with heart failure. Eur J Heart Fail, 2016, 18(5): 469-481.
8. Baumgartner H, Falk V, Bax JJ, et al. 2017 ESC/EACTS guidelines for the management of valvular heart disease. Kardiol Pol, 2018, 76(1): 1-62.
9. Cupido BJ, Peters F, Ntusi NA. An approach to the diagnosis and management of valvular heart disease. S Afr Med J, 2016, 106(1): 39-42.
10. Rossignol P, Hernandez AF, Solomon SD, et al. Heart failure drug treatment. Lancet, 2019, 393(10175): 1034-1044.
11. Metaxa S, Ioannou A, Missouris CG. Transcatheter aortic valve implantation: new hope in the management of valvular heart disease. Postgrad Med J, 2017, 93(1099): 280-288.
12. Kiss D, Anwaruddin S. Recent clinical trials in valvular heart disease. Curr Opin Cardiol, 2017, 32(4): 343-347.
13. Bashir M, Harky A, Bleetman D, et al. Aortic valve replacement: are we spoiled for choice? Semin Thorac Cardiovasc Surg, 2017, 29(3): 265-272.
14. Ferrao de Oliveira J, Antunes MJ. Nontransplant surgical options for congestive heart failure. Curr Cardiol Rep, 2004, 6(3): 225-231.
15. Cope JT, Kaza AK, Reade CC, et al. A cost comparison of heart transplantation versus alternative operations for cardiomyopathy. Ann Thorac Surg, 2001, 72(4): 1298-1305.
16. Parissis H, Graham V, Lampridis S, et al. IABP: history-evolution-pathophysiology-indications: what we need to know. J Cardiothorac Surg, 2016, 11(1): 122.
17. Rempher KJ. Continuous renal replacement therapy for management of overhydration in heart failure. AACN Clin Issues, 2003, 14(4): 512-519.
18. Rogers C, Bush N. Heart failure: pathophysiology, diagnosis, medical treatment guidelines, and nursing management. Nurs Clin North Am, 2015, 50(4): 787-799.

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The surgical treatment strategy and perioperative management of patients with heart valve disease complicated with severe chronic heart failure

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