ObjectiveTo summarize the efficacy of different anticoagulation methods during perioperative period of non-cardiac surgery after cardiac valve replacement and to compare the postoperative bleeding-related complications and embolization-related complications.MethodsRetrospective analysis of clinical data of 56 patients who underwent non-cardiac surgery after cardiac valve replacement in our hospital from January 2016 to January 2018 was conducted. There were 27 males and 29 females, aged 19-75 (53.56±13.94) years. According to different anticoagulation methods during perioperative period, the patients were divided into a bridging group (32 patients) and a non-bridging group (24 patients). The postoperative hospital stay, the number of patients needing postoperative blood transfusions, bleeding-related complications and embolization-related complications were compared between the two groups. According to the patient’s perioperative embolization risk, each group of patients were divided into a high-risk subgroup, middle-risk subgroup, and low-risk subgroup, and the bleeding-related complications and embolization-related complications in each subgroup were compared.ResultsThe postoperative hospital stay in the bridging group was significantly longer than that in the non-bridging group (P<0.05), but there was no significant difference in the number of patients needing postoperative blood transfusions, overall bleeding-related complications and embolization-related complications between the two groups (P>0.05). Subgroup analysis was performed according to the degree of embolization risk in the perioperative period. The incidence of bleeding-related complications of the non-bridging group in the high-risk subgroup was significantly higher than that in the high-risk subgroup of the bridging group (P<0.05). The incidence of bleeding-related complications in the bridging group was similar to that of embolization-related complications, while the rate of bleeding-related complications in the non-bridging group was 7 times higher than that of embolization-related complications.ConclusionBridging anticoagulation increases the length of postoperative hospital stay, but for patients with high risk factors for embolization, it is more beneficial than continuing oral warfarin during the perioperative period. The incidence of bleeding-related complications associated with continued warfarin therapy is significantly higher than that of embolization-related complications, and hemostatic drugs can be given necessarily.
Patients with cardiac diseases undergoing non-cardiac surgery have high risk and mortality. Management of these kind of patients is complicated and difficult. Appropriate use of circulation monitoring is good for clinical decision making and prognosis improvement. This article reviews the circulation monitoring technologies for patients with cardiac diseases undergoing non-cardiac surgeries from pressure monitoring, haemodynamics monitoring and cardiac structure and function monitoring. To choose suitable circulation monitor individually according to advantages, disadvantages and interference factors of every technology, the comorbidities and surgical characteristics can provide references for clinical decision making.