The Follow-up Study Of Patients Undergong Mechanical Valve Replacement

Objective: To summarize the experience and long-term follow-up results ofmechanical valve replacement of patients suffering from heart valve diseases, forsumming up effect, long-term efficacy and anticoagulation results of patientsunderwent heart valve replacement operation.Methods: From Jan2007to Dec2010,341heart valve diseases patients acceptedmechanical valve replacement in department of cardiothoracic surgery of the firstaffiliated hospital of bengbu medical college. Clinical datas of all patients, such asgender, age, valve etiology, past medical history, operation type, myocardialprotection way, CPB time, aortic blocking time, complications and mortality, werecollected and analysed to identify any obvious covariate interactions to early intervalmortality. Methods of follow-up included homemade questionnaire used byoutpatients, phone call and letter. The primary outcomes assessed by follow-upincluded late interval mortality and efficacy, anticoagulant treatment, and risk factorsof late mortality. Main clinical indicators include self-evaluation of patients, cardiacfunction standard of New York Heart Association, serious heart adverse events, andprothrombin time. The data obtained were analyzed using SPSS19.0statisticalsoftware. The mean±SD values were utilized to compare using ANOVO, and thequalitative variable datas using chi-square test. All P-values＜0.05were consideredstatistically significant.Results: There were120male cases (35.2%) and221female cases (64.8%) in ourstudy group, aging21to69years old (average46.53±10.03years). The follow-uptime was10.27±8.07years (one month to40years). There were rheumatic heartvalve disease310cases (90.9%), degenerative valve disease8cases (2.1%), infectiveendocarditis in7patients (2.3%), congenital heart disease in7patients (2.3%), othertype valve disease9cases (2.6%). According to NYHA cadiac function classification, there were2cases (0.59%) in gradeⅠ,17cases (4.99%) in gradeⅡ,298cases(87.39%) in gradeⅢ, and24cases (7.03%) in cases Ⅳ before operation. The heartrates of12patients were more than0.8, and other103cases were between0.7and0.8.Preoperative echocardiography and operation confirmed that mitral valve lesionsoccurred in229cases, aortic valve lesions in26cases, aortic and mitral valve lesionsin86cases, tricuspid insufficiency occurred in46patients. Past mdical illnessincluded hypertensive disease occurred in24cases, diabetes in17, liver or kidneydysfunction in6, severe pulmonary hypertension in112, left atrial thrombosis in51,atrial fibrillation in89cases and heart evil fluid to pledge in2cases. The mainassociated complications included left heart failure in149cases, right heart failure in29cases, coronary heart disease in2, mitral valve closed dilatation history in3, andother complications in11cases. The imported sorin double leaf mechanical valve,total replacement gien artificial427pieces,315pieces of mitral and aortic valve112pieces. Early postoperative complications in49cases: low heart valve syndrome in12cases, serious arrhythmia in16cases, postoperative bleeding heart cardiac tamponadein5cases, stop difficult in2cases, disc weeks in2cases, lungs, leakage incisioninfection such as9cases, cerebral infarction in1case, liver/kidney failure in2cases.For postoperative bleeding heart, cardiac tamponade and disc weeks leak line asecond surgery in5patients. Early death in6cases: low heart row in2cases, serioussyndrome arrhythmia in1case，postoperative bleeding/cardiac tamponade in1case，stop difficult in1case, paravalvular leakage in1case.316patients accepted ourfollow-up study, and the loss follow-up rate was5.57%. The follow-up time wasbetween9months to60months, total follow-up time was9959months, and theaverage time was2.13±13.98months. early deaths happened in6cases. There are6later deaths in our group, including2congestive heart failure,1bleeding fromanticoagulation,1thrombosis of the artificial valve,1endocarditis, and1cases ofmalignant tumor. The complications of anticoagulation included18mild hemorrhage,3moderate hemorrhage,1severe bleeding, and10thrombosis. According to NYHAcadiac function classification, there were262cases (84.5%) in grade Ⅰ,38cases in grade Ⅱ(12.3%), cases in grade Ⅲ (2.9%), and1cases (0.3%) in grade Ⅳ afteroperation.Conclusion: The heart valve replacement surgery is safe machinery; Operationmortality is acceptable, and there were no significant differences between domestic;Most of the patients who underwent the heart function and quality of life significantlyimprove; Postoperative long-term complications is bleeding complications in themajority; Patients should be tailored to the individual therapy and anticoagulant needuniversal anticoagulation knowledge.