Analysis Of Early Prognostic Factors In Patients With Mitral Stenosis After Surgery

Mitral stenosis(MS)is one of the common rheumatic heart disease(RHD).The incidence rate of simple MS is about 25%-45%,and the incidence rate of women is higher than that of men.Mitral valve replacement(MVR)is currently the main treatment for MS.The aim of this study is to retrospectively analyze the clinical data of MS patients after surgery,explore the factors that affect the early prognosis of MS patients after surgery,and provide reference for clinical diagnosis and treatment.Objective:The application time of the ventilator and the residence time in the intensive care unit(ICU)are commonly used early prognostic indicators after cardiac surgery.The purpose of this study is to identify the risk factors that affect the early postoperative prognosis of MS patients during the perioperative period,in order to guide and modify the patient’s treatment plan,in order to reduce the time of ventilator application and ICU stay,and improve the patient’s prognosis.Methods:Collect the medical records of patients with rheumatic MS who were diagnosed at TEDA International Cardiovascular Hospital from January 1,2013 to December 31,2022,and were over 18 years old and were scheduled to undergo mitral valve replacement;Patients who underwent emergency rescue surgery,complicated with aortic dissection,complicated with infective endocarditis,complicated with malignant tumor,complicated with hematological system disease,preoperative maintenance hemodialysis treatment and renal transplantation,and survived less than 24 hours after operation were excluded.The ventilator application time and ICU retention time after MS operation were regarded as the observation indicators of early postoperative prognosis.According to whether the ventilator application time exceeded 24h,they were divided into ventilator delay group(>24h)and non-ventilator delay group(≤24h);According to whether the detention time in ICU exceeds 72h,it is divided into ICU delay group(≥72h)and non-ICU delay group(<72h).The clinical data of patients were collected,and the factors affecting the early prognosis of MS patients after surgery were analyzed by single factor and multiple factor logistic regression.Results:A total of 343 eligible MS patients were included during the study.Among them,106 were male(31%)and 237 were female(69%).The average age was(56.7 ± 9.6)years.The results of multivariate association analysis showed age,stroke history,body mass index(BMI),coronary artery disease,severe pulmonary hypertension(PAH),mitral valve stenosis area,Vasoactive drug index score(VIS),surgical time,pulmonary infection,heart failure or hemodynamic instability,arrhythmia The size of the replacement valve is an independent influencing factor for ventilator delay;Age,BMI,total cholesterol,cardiac function grading,PAH grade,coronary artery disease status,cardiopulmonary bypass(CPB)time,pulmonary infection,secondary thoracotomy,heart failure or hemodynamic instability,and arrhythmia are independent influencing factors for postoperative ICU delay.Conclusions:Patient age,stroke history,coronary artery disease,severe PAH,VIS,surgical time,pulmonary infection,heart failure or hemodynamic instability,and arrhythmia are risk factors for delayed ventilation,while BMI,mitral valve stenosis area,and replacement valve size are protective factors for delayed ventilation;Patient age,cardiac function grading,PAH grade,coronary artery disease,CPB time,pulmonary infection,secondary thoracotomy,heart failure or hemodynamic instability,and arrhythmia are risk factors for delayed ICU,while BMI and total cholesterol are protective factors for delayed ICU.