The Pathogenesis And Efficacy Analysis Of Redo Cardiac Valve Replacement

Objective:1.To summarize surgical experiences and pathogenesis of patients underwent redo heart valve replacement.2.To summarize surgical experiences and pathogenesis of rodo mechanical valve replacement.To investigate the possible pathogenesis and report our 6 years surgical experiences of mechanical valve dysfunctionMethods:1.Clinical data of 285 consecutive patients who underwent redo heart valve surgery from March 2007 to October 2013 in Xinqiao Hospital of Third Military Medical University was retrospectively analyzed.There were 92 male patients and 193 female patients aging from 2 years old to 72 years old.Following variables were collected: preoperative morbidity,heart function,initial surgical strategies,indications and surgical strategies of redo heart valve replacement,mortality of perioperative period.Multivariate logistic regression was used to analyze the risk factors of perioperative death of patients undergoing redo heart valve surgery.2.52 consecutive individuals had undergone redo mechanical valve replacement because of MVD.All of the 52 consecutive individuals underwent redo mechanical valve replacement at our institution in the 6 years time were included in our study.Clinical data of the 52 consecutive individuals include preoperative morbidity,cardiac function,possible pathogenesis of MVD,surgical strategies of redo mechanical valve replacement,mortality in perioperative period were retrospectively analyzed and compared with clinical materials of individuals redo heart valve surgery for other reasons,such as bioprosthetic valve failure,mitral valve restenosis after mitral commissurotomy and other new pathogenesis during the 6 years time in Xinqiao hospital.All of the participants in our study gave written informed consent.And we also had obtained the written informed consent from the statutory guardian of the minors of enrolled in our study.Results:1.The reasons of redo heart valve surgery were mitral valve restenosis after mitral commissurotomy,bioprosthetic valve failure,mechanical prosthetic valve dysfunction and other new pathogenesis.18 patients died in the perioperative with the overall mortality 6.31%.The main reasons of the perioperative period death included low cardiac output syndrome(LCOS),malignant arrhythmia,respiratory failure,heart failure and multiple organ dysfunction(MODS).Multivariate logistic regression showed that patients have other system diseases,(OR = 3.530,P = 0.049),New York Heart Association(NYHA)class IV(OR = 4.025,P =0.025),aortic crossclamp time longer than 120 min(OR = 5.748,P = 0.004),intubate and ventilator time longer than 24 hours(OR =4.770,P = 0.025)are independent risk factors of perioperative death of patients underwent redo heart valve surgery.2.The reasons of MVD are perivalvular leakage,infectious endocarditis,prosthetic valve thrombosis,proliferation of fibrous tissue and any other reasons.All of the 52 individuals were undergone redo mechanical valve prosthesis replacement and 7 patients died in the early-stage with the overall mortality of 13.46%.The main reasons of the perioperative period death included low cardiac output syndrome(LCOS),malignant arrhythmia and multiple organ failure.All of the other individuals were clinicallycured and discharged.And 9 patients dead in our 6 years review.Conclusion:1.Redo heart valve surgery is a difficult surgical procedure with much higher risks.Adequate operation time,effective myocardial preservation in operation and reasonable perioperative.2.Surgical management of MVD has high mortality and complex surgical procedures,but up to now,surgical management is still one of the most effective ways to treat MVD.Adequate surgery time,improve the cardiac function pre-operation,effective myocardial preservation in surgery and reasonable perioperative management are helpful to improve the postoperative and mid-term outcomes of the surgical management of MVD.