Objective To analyze and explore the risk factors of secondary tricuspid regurgitation (TR) after left-sided valve surgery (left cardiac valve replacement or valvuloplasty) using meta-analysis, so as to provide evidence for clinical diagnosis and treatment of secondary TR. Methods We electronically searched databases including PubMed, MEDLINE, CBM, CNKI, VIP, for literature on the risk factors of secondary TR after left-sided valve surgery from 1995 to 2012. According to the inclusion and exclusion criteria, we screened literature, extracted data, and assessed methodological quality. Then, meta-analysis was performed using RevMan 5.0 software. Results A total of 6 case-control studies were included, involving 437 patients and 2 102 controls. The results of meta-analysis showed that, the risk factors of progressive exacerbation of secondary TR after left-sided valve surgery included preoperative atrial fibrillation (OR=3.90, 95%CI 3.00 to 5.07; adjusted OR=3.04, 95%CI 2.21 to 4.16), age (MD=5.36, 95%CI 3.49 to 7.23), huge left atrium (OR=5.17, 95%CI 3.12 to 8.57; adjusted OR=1.91, 95%CI 1.49 to 2.44) or left atrium diameter (MD=4.85, 95%CI 3.18 to 6.53), degradation of left heart function (OR=2.97, 95%CI 1.73 to 5.08), rheumatic pathological change (OR=3.06, 95%CI 1.66 to 4.68), preoperative TR no less than 2+ (OR=3.52, 95%CI 1.26 to 9.89), and mitral valve replacement (MVR) (OR=2.35, 95%CI 1.68 to 3.30). Sex (OR=1.54, 95%CI 0.94 to 2.52) and preoperative pulmonary arterial hypertension (OR=1.28, 95%CI 0.77 to 2.12) were not associated with secondary TR after left-sided valve surgery. Conclusion The risk factors of progressive exacerbation of secondary TR after left-sided valve surgery include preoperative atrial fibrillation, age, huge left atrium or left atrium diameter, degradation of left heart function, rheumatic pathological change, preoperative TR no less than 2+, and MVR. Understanding these risk factors helps us to improve the long-time effectiveness of preventing and treating TR after left-sided valve surgery.
Abstract： Objective To establish a risk prediction model and risk score for inhospital mortality in heart valve surgery patients, in order to promote its perioperative safety. Methods We collected records of 4 032 consecutive patients who underwent aortic valve replacement, mitral valve repair, mitral valve replacement, or aortic and mitral combination procedure in Changhai hospital from January 1,1998 to December 31,2008. Their average age was 45.90±13.60 years and included 1 876 (46.53%) males and 2 156 (53.57%) females. Based on the valve operated on, we divided the patients into three groups including mitral valve surgery group (n=1 910), aortic valve surgery group (n=724), and mitral plus aortic valve surgery group (n=1 398). The population was divided a 60% development sample (n=2 418) and a 40% validation sample (n=1 614). We identified potential risk factors, conducted univariate analysis and multifactor logistic regression to determine the independent risk factors and set up a risk model. The calibration and discrimination of the model were assessed by the HosmerLemeshow (H-L) test and [CM(159mm]the area under the receiver operating characteristic (ROC) curve,respectively. We finally produced a risk score according to the coefficient β and rank of variables in the logistic regression model. Results The general inhospital mortality of the whole group was 4.74% (191/4 032). The results of multifactor logistic regression analysis showed that eight variables including tricuspid valve incompetence with OR=1.33 and 95%CI 1.071 to 1.648, arotic valve stenosis with OR=1.34 and 95%CI 1.082 to 1.659, chronic lung disease with OR=2.11 and 95%CI 1.292 to 3.455, left ventricular ejection fraction with OR=1.55 and 95%CI 1.081 to 2.234, critical preoperative status with OR=2.69 and 95%CI 1.499 to 4.821, NYHA ⅢⅣ (New York Heart Association) with OR=2.75 and 95%CI 1.343 to 5641, concomitant coronary artery bypass graft surgery (CABG) with OR=3.02 and 95%CI 1.405 to 6.483, and serum creatinine just before surgery with OR=4.16 and 95%CI 1.979 to 8.766 were independently correlated with inhospital mortality. Our risk model showed good calibration and discriminative power for all the groups. P values of H-L test were all higher than 0.05 (development sample: χ2=1.615, P=0.830, validation sample: χ2=2.218, P=0.200, mitral valve surgery sample: χ2=5.175,P=0.470, aortic valve surgery sample: χ2=12.708, P=0.090, mitral plus aortic valve surgery sample: χ2=3.875, P=0.380), and the areas under the ROC curve were all larger than 0.70 (development sample: 0.757 with 95%CI 0.712 to 0.802, validation sample: 0.754 and 95%CI 0.701 to 0806; mitral valve surgery sample: 0.760 and 95%CI 0.706 to 0.813, aortic valve surgery sample: 0.803 and 95%CI 0.738 to 0.868, mitral plus aortic valve surgery sample: 0.727 and 95%CI 0.668 to 0.785). The risk score was successfully established: tricuspid valve regurgitation (mild:1 point, moderate: 2 points, severe:3 points), arotic valve stenosis (mild: 1 point, moderate: 2 points, severe: 3 points), chronic lung disease (3 points), left ventricular ejection fraction (40% to 50%: 2 points, 30% to 40%: 4 points, ＜30%: 6 points), critical preoperative status (3 points), NYHA IIIIV (4 points), concomitant CABG (4 points), and serum creatinine (＞110 μmol/L: 5 points).Conclusion Eight risk factors including tricuspid valve regurgitation are independent risk factors associated with inhospital mortality of heart valve surgery patients in China. The established risk model and risk score have good calibration and discrimination in predicting inhospital mortality of heart valve surgery patients.
Objective To summarize safety and effectiveness of cryomaze ablation procedure concomitant with valve surgery. Methods We retrospectively investigated the clinical data of 62 patients (24 males and 38 females) with mean age of 49.4±14.2 years who underwent cryomaze ablation procedure concomitant with valve surgery in our hospital from August 2013 through July 2015. The heart rhythm of the patients after surgery was supervised by 12-leads electrical cardiogram respectively. Results The rate of sinus rhythm restored right after surgery was 98.4%. The rate of sinus rhythm restored at the time of discharge was 93.4%. The rate of sinus rhythm restored 3 months, 6 months, 12 months, 18 months after surgery was 90.2%, 87.3%, 85.0%, 83.3% respectively. The one-year post-operation rate of sinus rhythm restored for the group of right minimal invasive thoracoscopic assisted mitral valve surgery was 90.5%. Longer duration for atrial fibrillation (>7 years) was a risk factor for the reoccurrence of atrial fibrillation 1 year after surgery (P<0.05). Conclusion Cryomaze ablation procedure concomitant with valve surgery is quite effective in treatment of rheumatic valve disease and atrial fibrillation. This approach is associated with fewer complications, comparable atrial fibrillation reoccurrence for short-term follow-up.