Clinical Analysis Of Cases Undergoing Aortic Valve Replacement In The Long Term After Mitral Valve Replacement

Objective: To analyze the causes, treatment and curative effect of cases undergoing aortic valve replacement in the long term after mitral valve replacement. To provide treatment experience of the cases for clinical diagnosis and treatment.Methods: Clinical data of 55 patients who underwent aortic valve replacement because of aortic valve disease in the long term after mitral valve replacement in the Union Hospital of Fujian Medical University from January 1, 2008 to December 31, 2014 were retrospectively analyzed. Of them there were 21 males and 34 females with a mean age of(50.6±7.0) years old. For them It was 15.4±5.4 years after the first heart operation. The second heart surgical included aortic valve replacement(AVR) in 51 cases, double valve replacement(DVR) in 4 cases, tricuspid valve plasty in 10 cases, left atrial folding in 1 case. Bileaflet mechanical valves were used for replacement in all cases. Heart function was compared before and after operation according to the New York Heart Association(NYHA).All patients were followed by clinic interview or telephone.Results: The main reasons of the cases undergoing aortic valve replacement in the long term after mitral valve replacement including rheumatic disease exacerbation(70.90%), aortic valve deterioration(25.5%), infective endocarditis vegetations(3.60%). 2 patients died of multiple organ failure, operation mortality was 3.64%. The time staying in the intensive unit(ICU) was 1-7days, an average of 2.4±1.1 days. The time staying in the hospital was 10-44 days, an average of 20.5±10.1 days. Postoperative complications occurred in 45 patients(45.5% patients). the average follow-up time was 30 months, and no deaths happened during follow-up. The clinicalmanifestations of the patients relieved obviously. The heart function was recovered to a certain extent, the number of preoperative heart function grade I,II,III,IV was 11,32,10 and 0. Through comparing preoperative and postoperative echocardiography data of the survival cases, we found :for about 1 week after operation, the LVEDD and the LA showed significant retraction comparing with the preoperative data(P < 0.05), while LVEF, LVFS and cardiac function grade had no significant difference comparing with the preoperative data(P>0.05). For 3 months after discharge, the LA, the LVEF, the LVEDD,the LVFS and heart function grade showed significant Recovery(P<0.05).Conclusion: 1. Rheumatic disease exacerbation, aortic valve deterioration, infective endocarditis vegetations were the three causes for the cases undergoing aortic valve replacement in the long term after mitral valve replacement. 2. With the enough attention to risk factors before operation, the improvement of heart function before operation, the right choice of operation time, the competent myocardial protection, the reasonable surgical method and the right perioperative treatment, the surgery of aortic valve replacement in the long term after mitral valve replacement can achieve a good effect. 3. Postoperative guidance should be given for the discharged patients and the follow-up should be taken,The short-term effect of this operation is remarkable,but the long-term effect needs to be further studied.