Etiological Analysis And Clinical Effect Of Re-operation For Replacement Of Aortic Valve After Corrective Heart Surgery

Objective:To analyze the clinical data of patients who underwent aortic valve replacement again in our hospital from January 2010 to December 2017,this study summarize the preoperative indicators of patients who underwent aortic valve replacement again after cardiac surgery,and summarize the related complications after the second operation.The study aim to explore the relationship between the second preoperative related indicators and the incidence of aortic valve replacement,to provide reference for perioperative management of patients after aortic valve replacement,and to provide basis for reducing the incidence of reoperationMethods:63 patients who underwent first heart disease correction surgery in January 2010-2017 December were collected.Their clinical data were recorded,including gender,age,smoking,hyperlipidemia,hypertension,pulmonary hypertension,atrial fibrillation,diabetes,coronary heart disease,pulmonary infection,cardiac function,serum creatinine,heart index,B BNP,FEV1/FVC.Left ventricular ejection fraction（LVEF）,left atrial diameter（LAD）,left ventricular end diastolic diameter（LVEDD）and oxygenation index（OI）were measured by SPSS 18.0 software.The causes,influencing factors,postoperative complications and prognosis of aortic valve replacement after heart disease correction were analyzed.Results:A total of 26 patients were included in this study.The reasons for re aortic valve replacement were as follows:aggravation of rheumatic disease of aortic valve（30.8%）,postoperative aortic stenosis（23.1%）,perivalvular leakage after mechanical valve operation（19.2%）,valve infection after mechanical valve operation（11.5%）,damage after bioprosthetic valve operation（7.7%）,and acute aortic mechanical valve sticking（7.7%）.The survival rate of patients after reoperation within half a year was 84.6%,and the survival rate of patients after reoperation within two years was 76.9%.The incidence of complications after reoperation was as follows:low cardiac output（53.8%）,renal insufficiency or failure（30.8%）,atrial fibrillation（30.8%）,pulmonary infection（26.9%）,atrioventricular block（26.9%）,pericardial tamponade（23.1%）,cerebral infarction（19.2%）,multiple organ dysfunction or even failure（15.4%）.Severe low cardiac output is the main complication after aortic valve replacement,followed by renal insufficiency or failure,atrial fibrillation,atrioventricular block and pulmonary infection（smoking cessation was not strictly followed before operation）.The incidence of reoperation for aortic valve replacement was closely related to preoperative smoking,low preoperative left ventricular ejection fraction and small preoperative left ventricular end diastolic diameter（P<0.05）.Conclusion:The main causes of repeated aortic valve replacement were aggravation of rheumatic disease,postoperative aortic stenosis,perivalvular leakage after mechanical valve operation,valve infection after mechanical valve operation,acute aortic mechanical valve sticking and biological valve damage.The effect of aortic valve replacement after cardiac surgery is accurate.But the postoperative mortality was high,accounting for 23.1%;There were many complications,accounting for 226.9%（cured cases accounted for 134.5%）.Preoperative smoking,low preoperative left ventricular ejection fraction and small preoperative left ventricular end diastolic diameter will directly increase the incidence of aortic valve replacement after cardiac surgery.In order to ensure the success of aortic valve replacement,the etiology should be clarified before operation,the surgical indications should be strictly grasped,the fine operation should be performed during operation,and the perioperative management should be strengthened.