Objective To summarize the outcomes and clinical features for surgical treatment of nonischemic heart valve disease(HVD) combined with coronary artery disease(CAD), so that to get better surgical result. Methods From January 2000 to June 2007, 105 patients with the mean age of 61.96±7.61 years (range 36-79 years), underwent the combined procedures.The etiology of HVD included: 59 rheumatic valve disease, 24 degenerative mitral lesion, 13 calcified aortic valve lesion, and 9 other aortic valve disease. CAD was preoperatively diagnosed by coronary arteriongraphy in 98 patients, and intraoperatively identified in 7 patients. Left ventricular ejection fraction was 50% or less in 45 patients. The total number of bypass grafts was 216 with the mean of 2.06 grafts per patient. Valve procedures included: 36 mitral valve valve replacement, 15 mitral repair,43 aortic valve replacement, 11 mitral valve and aortic valve replacement. Results There were 6 postoperative deaths with the mortality of 5.7%. The causes of death were 3 low cardiac output syndrome, 2 renal failure, and 1 heart arrest resulting in multiple organs failure. Ninety-three survivals were followed up from 1 month to 7 years, 6 patients were missed on follow-up. There were no late death. New York Heart Association class Ⅰ was observed in 25 patients, class Ⅱ53, class Ⅲ 10 and class Ⅳ 5. One patient still had existential chest pain. Conclusion There were no typical angina in majority of patients with nonischemic HVD combined with CAD, coronary arteriongraphy must be taken in patients with the age of 50 years and more, or with the risk factors for CAD.Intraoperative myocardial protection is very important because CAD further deteriorates myocardial dysfunction caused by HVD.The decreased left ventricular function is the important factor affecting the surgical results and it is hard to evaluate the underlying cause before the operation.
Objective To retrospectively review the clinical experience and early surgical results of combined cardiac valve surgery and coronary artery bypass grafting （CABG）. Methods From Jan. 2000 to Dec. 2005, combined valve surgery and CABG was performed in 81 patients. 37 patients were rheumatic heart disease with coronary stenosis, and 44 patients were coronary artery disease with valvular dysfunction. Single vessel disease was in 18 patients, two vessels disease in 9 and triple-vessel disease in 54. All the patients received sternotomy and combined valve surgery and CABG under cardiopulmonary bypass. Mitral valve repair and CABG were done in 26 patients. Valve replacement and CABG were done in 55 patients with 49 mechanical valves and 16 tissue valves. Four patients had left ventricular aneurysm resection concomitantly. The number of distal anastomosis was 3.12 5= 1.51 with 66 left internal mammary arteries bypassed to left anterior descending. Post-operative intra-aortic balloon pump was required in 4 cases for low cardiac output syndrome. Results Two patients died of low cardiac output syndrome with multiple organs failure. 79 patients had smooth recovery and discharged from hospital with improved heart function. 64 patients had completed follow-up with 5 late non cardiac related death in a mean follow-up period of 14.2 months. Conclusion Combined one stage valve surgery and CABG is effective with acceptable morbidity and mortality.
ObjectiveTo assess the accuracy of European System for Cardiac Operative Risk Evaluation (EuroSCORE) model in predicting the in-hospital mortality of Uyghur patients and Han nationality patients undergoing heart valve surgery. MethodsClinical data of 361 consecutive patients who underwent heart valve surgery at our center from September 2012 to December 2013 were collected, including 209 Uyghur patients and 152 Han nationality patients. According to the score for additive and logistic EuroSCORE models, the patients were divided into 3 subgroups including a low risk subgroup, a moderate risk subgroup, and a high risk subgroup. The actual and predicted mortality of each risk subgroup were studied and compared. Calibration of the EuroSCORE model was assessed by the test of goodness of fit, discrimination was tested by calculating the area under the receiver operating characteristic (ROC) curve. ResultsThe actual mortality was 8.03% for overall patients, 6.70% for Uyghur patients,and 9.87% for Han nationality patients. The predicted mortality by additive EuroSCORE and logistic EuroSCORE for Uyghur patients were 4.03% and 3.37%,for Han nationality patients were 4.43% and 3.77%, significantly lower than actual mortality (P<0.01). The area under the ROC curve of additive EuroSCORE and logistic EuroSCORE for overall patients were 0.606 and 0.598, for Han nationality patients were 0.574 and 0.553,and for Uyghur patients were 0.609 and 0.610. ConclusionThe additive and logistic EuroSCORE are unable to predict the in-hospital mortality accurately for Uyghur and Han nationality patients undergoing heart valve surgery. Clinical use of these model should be considered cautiously.
In recent years, wearable devices have seen a booming development, and the integration of wearable devices with clinical settings is an important direction in the development of wearable devices. The purpose of this study is to establish a prediction model for postoperative pulmonary complications (PPCs) by continuously monitoring respiratory physiological parameters of cardiac valve surgery patients during the preoperative 6-Minute Walk Test (6MWT) with a wearable device. By enrolling 53 patients with cardiac valve diseases in the Department of Cardiovascular Surgery, West China Hospital, Sichuan University, the grouping was based on the presence or absence of PPCs in the postoperative period. The 6MWT continuous respiratory physiological parameters collected by the SensEcho wearable device were analyzed, and the group differences in respiratory parameters and oxygen saturation parameters were calculated, and a prediction model was constructed. The results showed that continuous monitoring of respiratory physiological parameters in 6MWT using a wearable device had a better predictive trend for PPCs in cardiac valve surgery patients, providing a novel reference model for integrating wearable devices with the clinic.