Observation On The Early Clinical Effect Of Surgical Treatment Of Valvular Heart Disease With Pulmonary Hypertension

Objective:To study the early clinical effect of valvular surgery in patients with valvular heart disease with pulmonary hypertension,and to analyze the factors affecting the curative effect,to provide a clinical basis for risk assessment of surgical treatment in patients with valvular heart disease with pulmonary hypertension.Methods:According to the strict inclusion and exclusion criteria,the clinical data of 228 patients with valvular heart disease complicated with pulmonary hypertension who underwent valvular surgery in our hospital from 2010.10 to 2019.10 were studied.The pulmonary artery systolic pressure was 35-129(61.95±21.07)mm Hg,aged 13-76(53.30±10.05)years old,and the course of the disease was 0.01-50.5(3.71±8.11)years,including 83 males(36.4%)and 145 females(63.6%).All the above patients underwent cardiac valve replacement under cardiopulmonary bypass to evaluate the early clinical effect after the operation.The changes of pulmonary artery systolic pressure(PASP),the ejection fraction of left ventricle(LVEF),the incidence of operative complications,and mortality were analyzed under different sex,age,degree of pulmonary hypertension(PH),and different grades of cardiac function(NYHA classification).Results:1.Age,cardiac function grade and the degree of PH are closely related to the early clinical effect after the operation.2.The postoperative changes of PASP and LVEF in patients aged > 60 years old [(33.75±16.52)mm Hg,(2.89±14.04)%] were lower than those in patients aged ≤ 60 years old [(35.34±15.21)mm Hg,(3.98±13.33)%],while the incidence of postoperative complications(11.3%)and mortality(5.7%)was significantly higher than those in ≤ 60 years old group(6.3%,4%).3.With the increase of cardiac function grade,the higher the postoperative PASP value,the lower the LVEF value,the higher the complication and mortality,the difference was statistically significant(P < 0.05).4.The higher the preoperative PASP,the greater the postoperative PASP value change(P<0.05),the greater the LVEF value change(P<0.05),the higher the postoperative complication rate and mortality rate(P<0.05),the difference is both statistical significances.5.There was no significant difference in postoperative efficacy among patients of different genders(P > 0.05).Conclusion:The efficacy of cardiac valvular surgery in patients with valvular heart disease complicated with pulmonary hypertension is related to age,but not to gender;the worse the preoperative cardiac function,the higher the postoperative complications and mortality;the higher the preoperative PASP level,the higher the postoperative complications and mortality,the worse the surgical effect.Therefore,accurate preoperative evaluation of patients’ high-risk factors,adequate preoperative preparation,and postoperative focus on respiratory and circulatory function are of great help to improve the surgical efficacy of patients with valvular heart disease complicated with pulmonary hypertension.