| Background and objectives:Rheumatic heart disease is one of the leading causes of aortic valve diseasein the world.For a long time,Surgery is the most effective treatment for aortic lesion.Aortic valve replacement using prosthetic valves instead of diseased aortic valves,it is mainly used for patients with aortic stenosis and/or Aortic Insufficiency.So,currently,it has become one of the effective means of treatment of rheumatic aortic lesions.It is confirmed that this method is effective,an d With the progress of cardiac surgery in China and the standardization of the diagnosis and operation,aortic valve replacement has become a conventional cardiac surgery operation.AVR mostly use interrupted suturing.interrupted suturing mainly include mattress suture and everting mattress suture.This study used a retrospective analysis method,to analyze the aortic valve replacement in patients with rheumatic heart disease,comparing the clinical effect of patients respectively accept mattress suture and everting mattress suture,with aimed to provide the theoretical basis for selecting the best suture method for aortic valve replacement.Methods1.Subjects ::Inclusive criteria(1)Patients with rheumatic heart disease are examined before surgery according to the medical history,symptoms,signs and chest X-ray and electrocardiogram(2).All the operations performed by the same surgical group.(3)Aortic valve replacement in Guangzhou First People’s Hospital cardiothoracic surgery From February 2010 to May 2016(4)Artificial aortic valve us Carbomedics Top Hat Supra-Anular Aortic valve prosthesis produced by orin Group Italia S.r.i company,artificial mitral valve us Carbomedics Standard Mitral Valve produced by orin Group Italia S.r.i company(5)to exclude patients with coronary atherosclerotic heart disease,congenital heart disease,heart reoperation and the aorta is oversize and requires the aortic root broadening.2.Subjects in Study Group:60 patients were selected randomly in this study.28 patients received AVR via mattress suture and 32 patients received AVR with everting mattress suture.3.Methods:Two group were analyzed retrospectively.The preoperative datas(age,gender,,cardiothoracic ratio,cardiac function Classification,aortic diameter,Aortic valve pressure gradient,Left ventricular end-diastolic diameter,ejection fractions),Perioperative datas(surgical operation,aortic clamping time,CPB time,prosthesis size,automatic Rebeating or defibrillation resuscitation,temporary pacemaker).postperative datas(ICU retention time after operation,positive inotropic drugs use time after surgery,postoperative hospital stay,pressure gradient,left ventricular ejection fraction and related complications(paravalvular leakage,low cardiac output,reoperation for bleeding,renal failure)).follow-up observation(aortic valve pressure gradient,ejection fraction,Left ventricular end-diastolic diameter,and complications(out of hospital mortality,mechanical valve failure,cerebrovascular accident,circumferential leakage,and gastrointestinal bleeding)).The count data and measurement data were statistical analyzed with chi-squaretest and T test by using SPSS 20.0 software.P less than 0.05 was considered statistically significant.Results:There was no significant difference with the age,gender,,cardiothoracic ratio,body surface area,cardiac function Classification,aortic diameter,Aortic valve pressure gradient,Left ventricular end-diastolic diameter,ejection fractions between the two groups(P > 0.05).The two groups have 3 cases of early died,mattress suture group 1 cases(the knot is broken during the operation,the gasket falls into the left ventricle and is forced to remove the suture,resulting in a long interruption of the heart and death due to low cardiac output after operation);and the everting mattress suture group 2 cases(one died of sudden severe arrhythmia and another died of multiple organ function failure and death).There was no significant difference with the postoperative complications(reoperation for bleeding,renal failure,paravalvular leakage,low cardiac output)(P>0.05).Mattress suture group(23.07 ± 1.49mm)can be implanted into the larger side of artificial heart valve than everting mattress suture group(21.88±1.34 m m)(P<0.05).Mattress suture group aortic clamping time(AVR:47.60±13.44 min,AVR with other operation: 82.56±17.68min),cardiopulmonary bypass time(AV R:73.90 AVR ±15.13 min,AVR with other operation: 116.5±22.3 min)are no significant difference with everting mattress suture group aortic clamping time(AVR:56.25± 14.55 min,,AVR with other operation: 86.50±17.10min),cardiopulmonary bypass time(AVR:79.33±18.66 min,AVR with other operation: 119.8±21.7min)(P>0.05),and it’s hospitalization time of ICU(73.93±12.41 hours),days of positive inotropic drugs(4.26±1.98 days),and the length of hospital stay after operation(10.04±1.93 days)are shorter than everting mattress suture group hospitalization time of ICU(81.52±15.03hours),days of positive inotropic drugs(5.36±2.36days),and the length of hospital stay after operation(11.74±1.94days)(P<0.05),it’s postoperative aortic valve pressure gradient(17.96±6.13 mm Hg)are lower than everting mattress suture group(22.97±7.75 mm Hg)(P<0.05),it’s postoperative ejection fractions(62%±4%)are higher than everting mattress suture group(53%±5%)(P<0.05),it’s postoperative Left ventricular end-diastolic diameter(4.80±0.59mm)lower than everting mattress suture group(5.16±0.49 m m)(P<0.05).After the operation,mattress suture group were followed up by 17.27±7.46 months and everting mattress suture group were followed up by 15.54±9.08 months.Postoperative follow-up echocardiography results(last echocardiogr aphic results in follow-up period): mattress suture group aortic valve pressure gradient(18.76±5.76 mm Hg)are lower than everting mattress suture group(24.85±7.35 mm Hg)(P<0.05),ejection fractions(63%±5%)are higher than everting mattress suture group(54%±7%)(P<0.05),left ventricular end-diastolic diameter(4.76±0.43mm)are lower than everting mattress suture group(5.06±0.42 m m)(P<0.05).There was no significant difference with the long-term follow-up death,mechanical valve failure,cerebrovascular accident,paravalvular leakage,gastrointestinal hemorrhage complications between the two group(P>0.05).Conclusion :1.In aortic valve replacement,mattress suture method is better than everting mattress suture,because the former is artificial valve ring contraction effect on the ring,it can be inserted into the larger side of artificial valve,improve postoperative ejection fraction,reduce postoperative left ventricular end diastolic diameter and reduce postoperative Aortic valve pressure gradient.2.The long-term heart function is superior of mattress suture group is betterthan everting mattress suture group,mainly due to the implantation of larger side of artificial valve,the smaller Aortic valve pressure gradient,and the patency of the left ventricular outflow tract... |
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