The Outcome Analysis Of Combined Aortic And Mitral Replacement In Rheumatic Heart Disease And Myocardial Protection During The Operation

Background:Rheumatic heart valve disease is one of the common heart diseases in China. Valve replacement is the most effective and reliable treatment for this disease at present. However, there is much controversy about combined aortic and mitral replacement, whose proportion is 30% in all the valve replacement surgeries, especially in patients with small aortic valve rings. Various postoperative median and long-term effects have been reported in patients with small aortic valve prothesis. Although outcome of valve replacement has been significantly improved as a result of progress in knowledge about heart valve disease, surgical skills, cardiopulmonary bypass and myocardial protection technologies as well as prothesis engineering, the operation still causes mortality. Combined aortic and mitral valve replacement requires precise surgical skill and usually causes relatively high mortality. Low cardiac output syndrome is the main cause of mortality, which suggests insufficient myocardial protection during operation may result in myocardial injury besides underlying pathological changes of the disease. Retrograde cardioplegia via coronary sinus is frequently used to protect myocardium in combined aortic and mitral replacement, at present few clinical researches have been reported about the effect of this technique in patients with predominant aortic valve stenosis.Objective:1.Analyze risk factors of early death after heart valve replacement.2.Observe effect of combined aortic and mitral valve replacement with small aortic valve mechanical prothesis, explore the possible factors affecting median and long-term outcome.3.Investigate the best myocardial protective strategy in multiple valve disease patients with the main abnormay of aortic valve stenosis.