Surgical Clinical Analysis Of Valvular Heart Disease With Giant Left Ventricle

Objective:To summarize the perioperative management experience of patients with valvular heart disease complicated with giant left ventricle in our hospital and the short-term and long-term postoperative efficacy,and to explore the risk factors that may affect the early postoperative death and serious complications,so as to provide certain guidance for clinical work.Methods:From January 2017 to August 2019,51 patients with giant left ventricle underwent valve replacement in cardiothoracic surgery of Chuxiong people’s Hospital were collected and analyzed statistically and retrospectively.Results:1.51 patients with giant left ventricle with aortic vascular grafts 24 cases,ascending aorta replacement surgery of aortic valve replacement 21 cases,mitral valve replacement(3 cases),double valve replacement in 3,line 6 patients with tricuspid valvuloplasty during this period,the repair of atrial septal defects(5 cases,ventricular septal defect repair in 1 case,seam artery catheter in 1 case,aortic sinus aneurysm repair in 1 case,Coronary artery bypass grafting in 1 case.2.Forty-nine patients were discharged from hospital after surgery,and the average length of stay was(27.71±8.53)days.Postoperative complications occurred in 21 patients,accounting for 41.18%.Statistics showed that LAD≥42.5mm,CPB diversion time ≥156min,and aortic occlusion time ≥91min were risk factors for postoperative arrhythmias(P < 0.05).3.Improvement of the 49 patients discharged from hospital showed no obvious perivalvular leakage and replacement valve stenosis/regurgitation in color ultrasound reexamination half a year after surgery.LAD and LVEDD showed progressive reduction,while LVEF and FS were significantly improved(P < 0.01).4.Thirty-nine patients were successfully followed up for 12-24 months,with a follow-up rate of 79.59%.NYHA cardiac function classification: 26 patients(78.79%)were of Ⅰ grade,6 patients(18.18%)were of Ⅱ grade,and 1 patient(3.03%)were of Ⅲ grade,which was significantly improved compared with the previous 1 week(P < 0.01).5.There were 2cases of early postoperative death,with a mortality rate of 3.92%,and the main causes of death were malignant arrhythmia and multiple organ failure.The independent sample t-test for the factors affecting the early postoperative death of patients showed that "age" was statistically significant(P < 0.05),the average age of patients in the death group was significantly higher than that in the survival group.When "age" was included in Logisitic regression analysis,there was no statistical significance(P > 0.05).Conclusion:1.The short-term and long-term efficacy of valve replacement for patients with valvular heart disease complicated with giant left ventricle was reliable,and the cardiac ultrasound LAD,LVEDD,LVEF and FS were significantly improved six months after surgery compared with those before surgery;2.Preoperative cardiac ultrasound LAD≥42.5mm,CPB diversion time ≥156min,aortic occlusion time ≥91min were the risk factors for postoperative arrhythmias;3.Preoperative LVEF value was negatively correlated with postoperative ventilator-assisted time and hospitalization time of SICU.Perfection of cardiopulmonary support and active prevention and treatment of complications were important factors to improve the prognosis of patients.4.Ventricular fibrillation and multiple organ failure are important causes of early postoperative death;5.Active preoperative preparation and good timing of operation are the key to successful operation.