Risk Factors of In-hospital Death after Heart Valve Replacement in Xinjiang_Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Authors：

TURSUNAY , YUJing ,  ZHENGHong

Department of Anesthesia, First Teaching Hospital of Xinjiang Medical University, Urumqi 830054, P. R. China;

Corresponding author：

ZHENGHong, Email: xjzhenghong@aliyun.com

Keywords：

Valvular heart disease; Risk factor; Mortality

DOI：

10.7507/1007-4848.20150031

Video：

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Objective To investigate risk factors of in-hospital death of patient after heart valve replacement (HVR) in Xinjiang. Methods We retrospectively analyzed clinical data of 214 patients undergoing HVR in the First Teaching Hospital of Xinjiang Medical university from January 2011 to Month 2014. There were 96 male and 118 female patients with their age of 49.91±13.27 years. According to their postoperative prognosis, all the patients were divided into a death group (21 patients) and a survival group (193 patients). Risk factors of perioperative death were analyzed. Results In-hospital mortality was 9.81% (21/214). There was statistical difference in preoperative prothrombin time (PT), incidences of left ventricular ejection fraction (LVEF)≤50%, NYHA classⅣ, pulmonary arterial pressure (PAP) > 60 mm Hg, cardiopulmonary bypass time≥2 hours, concomitant coronary artery disease and renal failure between the 2 groups (P < 0.05). Logistic regression analysis showed that shortened preoperative PT, PAP > 60 mm Hg, NYHA classⅣand LVEF≤50% were independently risk factors of in-hospital death after HVR (P < 0.05). Conclusions Independent risk factors of in-hospital death of patients after HVR in Xinjiang include shortened preoperative PT, PAP > 60 mm Hg, NYHA classⅣand LVEF≤50%. Heightened caution is needed for patients with above risk factors to receive HVR after correction of those risk factors.

Citation： TURSUNAY, YUJing, ZHENGHong. Risk Factors of In-hospital Death after Heart Valve Replacement in Xinjiang. Chinese Journal of Clinical Thoracic and Cardiovascular Surgery, 2015, 22(2): 110-113. doi: 10.7507/1007-4848.20150031 Copy

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4.	余瑾, 詹海婷, 徐维芳, 等.不同评分模型对维吾尔族患者心脏瓣膜术死亡风险的预测价值.中华实用诊断与治疗, 2014, 28(3):241-243.
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6.	张小飞, 肖亦敏, 程云阁, 等.心脏机械瓣膜置换术后华法林低强度抗凝治疗的临床分析.中国胸心血管外科临床杂志, 2014, 21(2):270-271.
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12.	Hassan A, Quan H, Newman A, et al. Outcomes after aortic and mitral valve replacement surgery in Canada:1994/95 to 1999/2000. Can J Cardiol, 2004, 20(2):155-163.
13.	Han QQ, Xu ZY, Zhang BR, et al. Primary triple valve surgery for advanced rheumatic heart disease in Mainland China:a singlecenter experience with 871 clinical cases. Eur J Cardiothorac Surg, 2007, 31(5):845-850.
14.	Kerchove L, Vanoverschelde JL, Poncelet A, et al. Reconstructive surgery in active mitral valve endocarditis:feasibility, safety, and durability. Eur J Cardiol thorac Surg, 2007, 31(4):592-599.
15.	Hannan EL, Wu C, Bennett ET, et al. Risk index for predicting inhospital mortality for cardiac valve surgery. Ann Thorac Surg, 2007, 83(3):921-929.
16.	Shi JH, Meng X, Han J, et al. A mortality risk assessment model for cardiac valve replacement surgery and its application in the use of prophylactic extracorporeal membrane oxygenation. Int J Surg, 2010, 95(3):227-231.
17.	Chalmers J, Pullan M, Mediratta N, et al. A need for speed? Bypass time and outcomes after isolated aortic valve replacement surgery. Interact Cardiovasc Thorac Surg, 2014, 19(1):21-26.
18.	Salis S, Mazzanti VV, Merli G, et al. Cardiopulmonary bypass duration is an independent predictor of morbidity and mortality after cardiac surgery. J Cardiothorac Vasc Anesth, 2008, 22(6):814-822.
19.	马幸生, 杨双强.冠状动脉造影在风湿性心瓣膜病行心瓣膜置换术患者中的临床应用及意义.中国胸心血管外科临床杂志, 2013, 20(4):414-419.
20.	Alsoufi B, Rao V, Borger MA, et a1. Short-and long-term results of triple valve surgery in the modern era. Ann Thorac Surg, 2006, 81(6):2172-2177.
21.	Sinning JM, Hammersting C, Chin D, et al. Decrease of pulmonary hypertension impacts on prognosis after transcatheter aortic valve replacement. Euro Intervention, 2014, 9(9):1042-1049.
22.	Ben-Dor I, Goldstein SA, Pichard AD, et al. Clinical profile, prognostic implication, and response to treatment of pulmonary hypertension in patients with severe aortic stenosis. Am J Cardiol, 2011, 107(7):1046-1051.
23.	Roselli EE, Abdel Azim A, Houghtaling PL, et al. Pulmonary hypertension is associated with worse early and late outcomes after aortic valve replacement:implications for transcatheter aortic valve replacement. J Thorac Cardiovasc Surg, 2012, 144(5):1067-1074.
24.	Rodés-Cabau J, Webb JG, Cheung A, et al. Transcatheter aortic valve implantation for the treatment of severe symptomatic aortic stenosis in patients at very high or prohibitive surgical risk:acute and late outcomes of the multicenter Canadian experience. J Am Coll Cardiol, 2010, 55(11):1080-1090.
25.	徐宏耀, 王平凡, 梁志强, 等.心瓣膜置换术的影响因素分析.中国胸心血管外科临床杂志, 2009, 16(4):322-324.

1. Rabkin E, Schoen FJ. Cardiovascular tissue engineering. Cardiovasc Pathol, 2002, 11(6):305-317.
2. Roques F, Nashef SA, Michel P, EuroSCORE Project Group. Regional differences in surgical heart valve disease in Europe:comparison between northern and southern subsets of the EuroSCORE database. J Heart Valve Dis, 2003, 12(1):1-6.
3. 邓木兰, 李河, 陈剑光, 等.广东、新疆中小学生及成人风湿性心瓣膜病流行病学调查.南方医科大学学报, 2009, 29(9):1902-1904.
4. 余瑾, 詹海婷, 徐维芳, 等.不同评分模型对维吾尔族患者心脏瓣膜术死亡风险的预测价值.中华实用诊断与治疗, 2014, 28(3):241-243.
5. Ishibashi-Ueda H, Imakita M, Katsuragi M, et al. An analysis of autopsy findings in 108 patients who died after valve replacement. Viwhows Arch A Pathol Anat Histopathol, 1993, 422(5):397-403.
6. 张小飞, 肖亦敏, 程云阁, 等.心脏机械瓣膜置换术后华法林低强度抗凝治疗的临床分析.中国胸心血管外科临床杂志, 2014, 21(2):270-271.
7. Essop MR, Nkomo VT. Rheumatic and nonrheumatic valvular heart disease:epidemiology, management, and prevention in Africa. Circuiation, 2005, 112(23):3584-3591.
8. Nkomo VT, Gardin JM, Skelton TN, et al. Burden of valvular heart diseases:a population-based study. Lancet, 2006, 368(9540):1005-1011.
9. Iung B, Baron G, Butchart EG, et al. A prospective survey of patients with valvular heart disease in Europe:The Euro Heart Survey on Valvular Heart Disease. Eur Heart J, 2003, 24(13):1231-1243.
10. Larry Z, Bloomstein BS, Isaac Gielchinsky MD, et a1. Aortic valve replacement in geriatric patients:determinants of in-hospital mortality. Ann Thorac Surg, 2001, 71(3):597-600.
11. Michael G, Rinaldo B, Laurie D, et al. Bench-to bedside review:Inotropic drug therapy after adult cardiac surgery-a systematic literature review. Critical Care, 2005, 9(5):266-279.
12. Hassan A, Quan H, Newman A, et al. Outcomes after aortic and mitral valve replacement surgery in Canada:1994/95 to 1999/2000. Can J Cardiol, 2004, 20(2):155-163.
13. Han QQ, Xu ZY, Zhang BR, et al. Primary triple valve surgery for advanced rheumatic heart disease in Mainland China:a singlecenter experience with 871 clinical cases. Eur J Cardiothorac Surg, 2007, 31(5):845-850.
14. Kerchove L, Vanoverschelde JL, Poncelet A, et al. Reconstructive surgery in active mitral valve endocarditis:feasibility, safety, and durability. Eur J Cardiol thorac Surg, 2007, 31(4):592-599.
15. Hannan EL, Wu C, Bennett ET, et al. Risk index for predicting inhospital mortality for cardiac valve surgery. Ann Thorac Surg, 2007, 83(3):921-929.
16. Shi JH, Meng X, Han J, et al. A mortality risk assessment model for cardiac valve replacement surgery and its application in the use of prophylactic extracorporeal membrane oxygenation. Int J Surg, 2010, 95(3):227-231.
17. Chalmers J, Pullan M, Mediratta N, et al. A need for speed? Bypass time and outcomes after isolated aortic valve replacement surgery. Interact Cardiovasc Thorac Surg, 2014, 19(1):21-26.
18. Salis S, Mazzanti VV, Merli G, et al. Cardiopulmonary bypass duration is an independent predictor of morbidity and mortality after cardiac surgery. J Cardiothorac Vasc Anesth, 2008, 22(6):814-822.
19. 马幸生, 杨双强.冠状动脉造影在风湿性心瓣膜病行心瓣膜置换术患者中的临床应用及意义.中国胸心血管外科临床杂志, 2013, 20(4):414-419.
20. Alsoufi B, Rao V, Borger MA, et a1. Short-and long-term results of triple valve surgery in the modern era. Ann Thorac Surg, 2006, 81(6):2172-2177.
21. Sinning JM, Hammersting C, Chin D, et al. Decrease of pulmonary hypertension impacts on prognosis after transcatheter aortic valve replacement. Euro Intervention, 2014, 9(9):1042-1049.
22. Ben-Dor I, Goldstein SA, Pichard AD, et al. Clinical profile, prognostic implication, and response to treatment of pulmonary hypertension in patients with severe aortic stenosis. Am J Cardiol, 2011, 107(7):1046-1051.
23. Roselli EE, Abdel Azim A, Houghtaling PL, et al. Pulmonary hypertension is associated with worse early and late outcomes after aortic valve replacement:implications for transcatheter aortic valve replacement. J Thorac Cardiovasc Surg, 2012, 144(5):1067-1074.
24. Rodés-Cabau J, Webb JG, Cheung A, et al. Transcatheter aortic valve implantation for the treatment of severe symptomatic aortic stenosis in patients at very high or prohibitive surgical risk:acute and late outcomes of the multicenter Canadian experience. J Am Coll Cardiol, 2010, 55(11):1080-1090.
25. 徐宏耀, 王平凡, 梁志强, 等.心瓣膜置换术的影响因素分析.中国胸心血管外科临床杂志, 2009, 16(4):322-324.

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