The Characteristics Of The Elderly Patients Suffering From Heart Valve Surgery Clinical Studies

Objective:Valvular heart disease is an important factor causing death in elderly patients. With the aging of the population and the change of living environment, senile valve disease is increasing day by day and operation demand increase, due to cardiac surgery and extracorporeal circulation operation of various technology matures, the age factor is not the contraindication of operation, but because the elderly organ function decline, operation risk big, the incidence of complications and high mortality rate after operation comparison of clinical data, so the elderlyheart valve disease in≥60years and<60years old patients with valvular disease, to summarize the clinical experience of the treatment of elderly patients with valvular heart disease operation, in order to improve the success rate of operation and therapeutic effect.Methods:A retrospective analysis of Affiliated Hospital of Jining Medical College from heart surgery in1076patients with clinical data in2006January to2012July underwent cardiac valve operation, and according to inclusion and exclusion criteria into≥60group557patients, male255cases, female302cases, age75years old;60-(64.1±5.4). In the etiology, rheumatic valvular disease343cases, non rheumatic valvular heart disease214cases. Mitral valve replacement (MVR) in309cases, aortic valve replacement (AVR) in129cases, double valve replacement (DVR) in114cases, mitral valvuloplasty (MVP) in23cases, three tricuspid valvuloplasty (TVP) in95cases, three tricuspid valve replacement (TVR) in2cases. The group used biological flap in69cases, mechanical valve in370cases. Recurrent valvular heart disease operation again in60cases, preoperative routine coronary angiography, concurrent with CABG (most of which two branch lesions) in60cases, the rest of the left atrial thrombectomy, left atrial plication, radiofrequency ablation. Classification of cardiac function (NYHA) and121cases of IV grade, Ⅲ grade335cases, Ⅱ grade101cases. The<60age group519patients, male304cases, female215cases, age3-59years old (39.6±10.4years), the group with biological flap in15cases, mechanical valve in451cases.96cases of congenital heart disease,312cases of rheumatic valvular disease,111patients with valvular heart disease. Mitral valve replacement (MVR) in222cases, aortic valve replacement (AVR) in83cases, double valve replacement (DVR) in95cases, mitral valvuloplasty (MVP) in19cases, three tricuspid valvuloplasty (TVP) in34cases, and includes a line of tricuspid valve closed dilatation in5cases, recurrent valvular disease of the heart (two tricuspid valve closed dilatation, valvuloplasty, paravalvular leakage, mechanical prosthetic valve dysfunction, bioprosthetic valve failure causes) again operation in23cases, with the repair of atrial septal defect, repair of ventricular septal defect, ligation of ductus arteriosus, cardiac functional grading (NYHA)14cases of grade Ⅳ,192cases of grade Ⅲ,313cases of grade Ⅱ; clinical indexes of two groups were compared.Results:14cases died at the age of≥60group after operation, mortality rate was2.7%;17cases died aged<60group after operation, the mortality rate was3.1%; the main causes of death:9cases of multiple organ failure,6cases of malignant ventricular arrhythmia, low cardiac output syndrome in4cases,2cases of left ventricular rupture,3cases of respiratory failure,3cases of acute renal failure,1cases of mechanical valve failure,2cases of upper gastrointestinal bleeding,1cases of cerebral vascular accident. Application of biological valves ratio (2.9%vs12.5%), mechanical ventilation time d (1.1±0.3vs2.1±1.4), ICU d (2.3±0.7vs4.3±1.1), the length of time the d (21.7±3.9vs36.6±4.9) there are significant differences between the two groups (P<0.05); LVEDD (46.3±7.2vs46.9±7), LVEF (54.9±9.2vs49.0±9.6), mortality (2.7%vs3.1%), aortic cross-clamp time min (83.1±12.4vs85.9±27.1), cardiopulmonary bypass time min (108.7±8.5vs119.0±29.7) was not statistically significant, the difference between the two groups (P>0.05) see,Table2and3.Conclusion:The senile valve disease operation risk, so choose appropriate operation method, improve the preoperative preparation, shortening cardiopulmonary bypass and aortic cross-clamp time, treatment is safe for senile valve disease patients with surgical treatment to enhance myocardial protection and postoperative.