Objectives:To establish long-term outcome of surgical pulmonary valve replacement(PVR)in congenital heart disease(CHD)and to identify risk factors for overall mortality,operative mortality,and repetitive PVR.Methods:T...Objectives:To establish long-term outcome of surgical pulmonary valve replacement(PVR)in congenital heart disease(CHD)and to identify risk factors for overall mortality,operative mortality,and repetitive PVR.Methods:This is a retrospective study of 375 surgical PVR in 293 patients who underwent surgical PVR for CHD between January 2000 and May 2020.We only included patients with index PVR with previous open-heart surgery regardless of the number of PVRs.The previous surgical history of patients who underwent PVR during the study period was also included.Patients who underwent the Rastelli operation,and those who underwent single PVR without previous open-heart surgery were excluded.Results:The median age of the patients at the time of surgical PVR was 14.9 years(Interquartile range,IQR,11.0–22.0).The median follow-up duration was 10.5 years(IQR,5.5–14.8 years).There were 3 patients with operative mortality(1.0%)and 15 patients with overall mortality(5.1%).The survival rate was 95.1%over 20 years follow-up period.Multivariate analysis demonstrated that more than 3 times of previous open-heart surgeries before surgical PVR,older age at the first operation,longer cardiopulmonary bypass(CPB)time and longer intensive care unit(ICU)stay were predictors for overall mortality.Patients who underwent surgical PVR after more than 3 times of previous open-heart surgeries had significantly higher mortality than those who underwent open-heart surgeries less than 3 times(P<0.001).Age younger than 10 years,male,multiple valve problems and longer ICU stay were significant predictors for repetitive PVR by multivariate analysis.Conclusions:Though surgical PVR has excellent long-term outcome,it should be performed with caution for those who previously underwent multiple open-heart surgeries,especially if patient received more than 3 times of open-heart surgeries.展开更多
Background Numerous studies have developed a ＂severity score＂ or ＂risk index＂ for short-term mortality associated with coronary artery bypass grafting （CABG）. Due to the different distribution of disease types, ...Background Numerous studies have developed a ＂severity score＂ or ＂risk index＂ for short-term mortality associated with coronary artery bypass grafting （CABG）. Due to the different distribution of disease types, the number of valve surgeries in the US and Europe is relatively small. Thus, a risk-scoring system for valve surgeries was developed later and used less than that for the CABG surgery. We retrospectively reviewed 5128 cases of heart valve replacement, to quantitatively assess the risk factors for hospital mortality, and establish risk models for the hospital mortality of cardiac valve replacement patients.Methods A total of 1549 cases of aortic valve replacement, 2460 cases of mitral valve replacement, and 1119 cases of combined aortic valve and mitral valve replacement that were recorded from January 2005 to December 2009 in the cardiac surgery database at Beijing Anzhen Hospital were selected for this study. The cases were randomly assigned to a indicators were selected as possible influencing factors for hospital mortality. Single-factor analysis was performed to screen these factors, and then multi-factor analysis was used to determine the risk factors for hospital mortality in the three surgeries and to establish risk models.Results In the multi-factor analysis, age, body surface area, etiology, cardiopulmonary bypass time, preoperative cardiothoracic ratio, cardiac functional classification, and preoperative creatinine were risk factors for aortic valve replacement. Etiology, preoperative history of heart failure, cardiopulmonary bypass time, preoperative cardiothoracic ratio, and preoperative left ventricular end systolic diameter were risk factors for mitral valve replacement. Age, body mass index, cardiopulmonary bypass time, and cardiac function classification were risk factors for combined aortic valve and mitral valve replacement. The risk models showed good predictive ability （Hosmer-Lemeshow test： P=0.981 in the model for aortic valve replacement, P=0.503 in the model for mitral valve replacement, and P=0.154 in the model for combined aortic valve and mitral valve replacement）. The area under the ROC curve of the validation group was 0.958 （95% CI： 0.936-0.975） for the aortic valve replacement model, 0.876 （95% CI： 0.805-0.948） for the mitral valve replacement model, and 0.845 （95% CI： 0.753-0.939） for the combined aortic valve and mitral valve replacement,indicating that the risk models were good in predicting hospital mortality for surgeries.Conclusion The three risk models can quantitatively assess the hospital mortality risk in the patients treated with cardiac valve replacement.展开更多
Background Objective:To investigate the perioperative precautions,surgical methods and early clinical efficacy of patients with valvular heart disease complicated by coronary atherosclerotic heart disease treated with...Background Objective:To investigate the perioperative precautions,surgical methods and early clinical efficacy of patients with valvular heart disease complicated by coronary atherosclerotic heart disease treated with coronary artery bypass grafting at the same time as heart valve replacement and to analyze the relevant factors affecting the death of patients during hospitalization after surgery.Methods:Between January 2020 and September 2021,a total of 103 patients who underwent simultaneous heart valve replacement and coronary artery bypass grafting for heart valve disease in conjunction with coronary atherosclerotic heart disease at the Department of cardiac surgery,Guangdong Cardiovascular Institute were retrospectively evaluated for clinical data,and a systematic review and summary of all preoperative data,surgical methods,intraoperative data,and major complications were performed.The variations in each cardiotocography indicator were examined before and after surgery to determine surgical effectiveness and statistical perioperative patient mortality.After integrating the Sino SCORE risk assessment system and analyzing the case features included in this data,12 alternative risk variables for mortality were identified and submitted to univariate and multivariate analysis using logistic regression.After performing a univariate analysis of the alternative risk factors,the option of P<0.05 was considered a risk factor and included in the multivariate analysis,followed by a multivariate logistic regression analysis in which the factors were determined to be independent risk factors with P<0.05,and their OR values and 95 percent confidence intervals(CIs)were calculated to analyze the associated factors affecting patients’early prognosis systematically.Results:Of the 103 patients,91 were successfully discharged from the hospital,12 died,11.7%of the deaths were due to the following causes:postoperative low cardiac output syndrome,multiple organ failure,and severe infection;Among all the 103 patients,7 patients underwent rebleeding and hemostasis after surgery,6 patients required dialysis after surgery,28 patients underwent IABP supportive care after surgery because of the occurrence of low cardiac output syndrome,1 patient assisted by ECMO after surgery,and patients discharged successfully had significantly less LVEDD and LVESD in the early postoperative period,compared with those before surgery(P=0.000;P=0.000).Age>70 years,preoperative combined hyperlipidemia,and history of the cerebrovascular accident were the three independent risk factors that may have contributed to in-hospital mortality in patients undergoing CABG valve replacement.Conclusions:1.The diastolic function of the majority of patients with valvular heart disease and coronary atherosclerotic heart disease improved significantly in the early stages after coronary artery bypass grafting and heart valve replacement.2.Age>70 years,preoperative combined hyperlipidemia,and a history of the cerebrovascular accident were three independent risk factors for in-hospital death in patients receiving CABG valve replacement.展开更多
Background:Postoperative pneumonia(POP)is one of the most common infections following heart valve surgery(HVS)and is associated with a significant increase in morbidity,mortality,and health care costs.This study aimed...Background:Postoperative pneumonia(POP)is one of the most common infections following heart valve surgery(HVS)and is associated with a significant increase in morbidity,mortality,and health care costs.This study aimed to identify the major risk factors associated with the occurrence of POP following HVS and to derive and validate a clinical risk score.Methods:Adults undergoing open HVS between January 2016 and December 2019 at a single institution were enrolled in this study.Patients were randomly assigned to the derivation and validation sets at 1:1 ratio.A prediction model was developed with multivariable logistic regression analysis in the derivation set.Points were assigned to independent risk factors based on their regression coefficients.Results:POP occurred in 316 of the 3853 patients(8.2%).Multivariable analysis identified ten significant predictors for POP in the derivation set,including older age,smoking history,chronic obstructive pulmonary disease,diabetes mellitus,renal insufficiency,poor cardiac function,heart surgery history,longer cardiopulmonary bypass,blood transfusion,and concomitant coronary and/or aortic surgery.A 22-point risk score based on the multivariable model was then generated,demonstrating good discrimination(C-statistic:0.81),and calibration(Hosmer-Lemeshowχ^(2)=8.234,P=0.312).The prediction rule also showed adequate discriminative power(C-statistic:0.83)and calibration(Hosmer-Lemeshowχ^(2)=5.606,P=0.691)in the validation set.Three risk intervals were defined as low-,medium-,and high-risk groups.Conclusion:We derived and validated a 22-point risk score for POP following HVS,which may be useful in preventive interventions and risk management.Trial Registration:Chictr.org,ChiCTR1900028127;http://www.chictr.org.cn/showproj.aspx?proj=46932.展开更多
文摘Objectives:To establish long-term outcome of surgical pulmonary valve replacement(PVR)in congenital heart disease(CHD)and to identify risk factors for overall mortality,operative mortality,and repetitive PVR.Methods:This is a retrospective study of 375 surgical PVR in 293 patients who underwent surgical PVR for CHD between January 2000 and May 2020.We only included patients with index PVR with previous open-heart surgery regardless of the number of PVRs.The previous surgical history of patients who underwent PVR during the study period was also included.Patients who underwent the Rastelli operation,and those who underwent single PVR without previous open-heart surgery were excluded.Results:The median age of the patients at the time of surgical PVR was 14.9 years(Interquartile range,IQR,11.0–22.0).The median follow-up duration was 10.5 years(IQR,5.5–14.8 years).There were 3 patients with operative mortality(1.0%)and 15 patients with overall mortality(5.1%).The survival rate was 95.1%over 20 years follow-up period.Multivariate analysis demonstrated that more than 3 times of previous open-heart surgeries before surgical PVR,older age at the first operation,longer cardiopulmonary bypass(CPB)time and longer intensive care unit(ICU)stay were predictors for overall mortality.Patients who underwent surgical PVR after more than 3 times of previous open-heart surgeries had significantly higher mortality than those who underwent open-heart surgeries less than 3 times(P<0.001).Age younger than 10 years,male,multiple valve problems and longer ICU stay were significant predictors for repetitive PVR by multivariate analysis.Conclusions:Though surgical PVR has excellent long-term outcome,it should be performed with caution for those who previously underwent multiple open-heart surgeries,especially if patient received more than 3 times of open-heart surgeries.
文摘Background Numerous studies have developed a ＂severity score＂ or ＂risk index＂ for short-term mortality associated with coronary artery bypass grafting （CABG）. Due to the different distribution of disease types, the number of valve surgeries in the US and Europe is relatively small. Thus, a risk-scoring system for valve surgeries was developed later and used less than that for the CABG surgery. We retrospectively reviewed 5128 cases of heart valve replacement, to quantitatively assess the risk factors for hospital mortality, and establish risk models for the hospital mortality of cardiac valve replacement patients.Methods A total of 1549 cases of aortic valve replacement, 2460 cases of mitral valve replacement, and 1119 cases of combined aortic valve and mitral valve replacement that were recorded from January 2005 to December 2009 in the cardiac surgery database at Beijing Anzhen Hospital were selected for this study. The cases were randomly assigned to a indicators were selected as possible influencing factors for hospital mortality. Single-factor analysis was performed to screen these factors, and then multi-factor analysis was used to determine the risk factors for hospital mortality in the three surgeries and to establish risk models.Results In the multi-factor analysis, age, body surface area, etiology, cardiopulmonary bypass time, preoperative cardiothoracic ratio, cardiac functional classification, and preoperative creatinine were risk factors for aortic valve replacement. Etiology, preoperative history of heart failure, cardiopulmonary bypass time, preoperative cardiothoracic ratio, and preoperative left ventricular end systolic diameter were risk factors for mitral valve replacement. Age, body mass index, cardiopulmonary bypass time, and cardiac function classification were risk factors for combined aortic valve and mitral valve replacement. The risk models showed good predictive ability （Hosmer-Lemeshow test： P=0.981 in the model for aortic valve replacement, P=0.503 in the model for mitral valve replacement, and P=0.154 in the model for combined aortic valve and mitral valve replacement）. The area under the ROC curve of the validation group was 0.958 （95% CI： 0.936-0.975） for the aortic valve replacement model, 0.876 （95% CI： 0.805-0.948） for the mitral valve replacement model, and 0.845 （95% CI： 0.753-0.939） for the combined aortic valve and mitral valve replacement,indicating that the risk models were good in predicting hospital mortality for surgeries.Conclusion The three risk models can quantitatively assess the hospital mortality risk in the patients treated with cardiac valve replacement.
基金supported in part by the Research Team Project of Natural Science Foundation of Guangdong Province of China(No.2017A030312007)the Key Program of Guangzhou science research plan(No.201904020047)the Special Project of Dengfeng Program of Guangdong Provincial People’s Hospital(No.DFJH201812,No.KJ012019119,No.KJ012019423)。
文摘Background Objective:To investigate the perioperative precautions,surgical methods and early clinical efficacy of patients with valvular heart disease complicated by coronary atherosclerotic heart disease treated with coronary artery bypass grafting at the same time as heart valve replacement and to analyze the relevant factors affecting the death of patients during hospitalization after surgery.Methods:Between January 2020 and September 2021,a total of 103 patients who underwent simultaneous heart valve replacement and coronary artery bypass grafting for heart valve disease in conjunction with coronary atherosclerotic heart disease at the Department of cardiac surgery,Guangdong Cardiovascular Institute were retrospectively evaluated for clinical data,and a systematic review and summary of all preoperative data,surgical methods,intraoperative data,and major complications were performed.The variations in each cardiotocography indicator were examined before and after surgery to determine surgical effectiveness and statistical perioperative patient mortality.After integrating the Sino SCORE risk assessment system and analyzing the case features included in this data,12 alternative risk variables for mortality were identified and submitted to univariate and multivariate analysis using logistic regression.After performing a univariate analysis of the alternative risk factors,the option of P<0.05 was considered a risk factor and included in the multivariate analysis,followed by a multivariate logistic regression analysis in which the factors were determined to be independent risk factors with P<0.05,and their OR values and 95 percent confidence intervals(CIs)were calculated to analyze the associated factors affecting patients’early prognosis systematically.Results:Of the 103 patients,91 were successfully discharged from the hospital,12 died,11.7%of the deaths were due to the following causes:postoperative low cardiac output syndrome,multiple organ failure,and severe infection;Among all the 103 patients,7 patients underwent rebleeding and hemostasis after surgery,6 patients required dialysis after surgery,28 patients underwent IABP supportive care after surgery because of the occurrence of low cardiac output syndrome,1 patient assisted by ECMO after surgery,and patients discharged successfully had significantly less LVEDD and LVESD in the early postoperative period,compared with those before surgery(P=0.000;P=0.000).Age>70 years,preoperative combined hyperlipidemia,and history of the cerebrovascular accident were the three independent risk factors that may have contributed to in-hospital mortality in patients undergoing CABG valve replacement.Conclusions:1.The diastolic function of the majority of patients with valvular heart disease and coronary atherosclerotic heart disease improved significantly in the early stages after coronary artery bypass grafting and heart valve replacement.2.Age>70 years,preoperative combined hyperlipidemia,and a history of the cerebrovascular accident were three independent risk factors for in-hospital death in patients receiving CABG valve replacement.
基金supported by a grant from the National Natural Science Foundation of China(No.81800413)。
文摘Background:Postoperative pneumonia(POP)is one of the most common infections following heart valve surgery(HVS)and is associated with a significant increase in morbidity,mortality,and health care costs.This study aimed to identify the major risk factors associated with the occurrence of POP following HVS and to derive and validate a clinical risk score.Methods:Adults undergoing open HVS between January 2016 and December 2019 at a single institution were enrolled in this study.Patients were randomly assigned to the derivation and validation sets at 1:1 ratio.A prediction model was developed with multivariable logistic regression analysis in the derivation set.Points were assigned to independent risk factors based on their regression coefficients.Results:POP occurred in 316 of the 3853 patients(8.2%).Multivariable analysis identified ten significant predictors for POP in the derivation set,including older age,smoking history,chronic obstructive pulmonary disease,diabetes mellitus,renal insufficiency,poor cardiac function,heart surgery history,longer cardiopulmonary bypass,blood transfusion,and concomitant coronary and/or aortic surgery.A 22-point risk score based on the multivariable model was then generated,demonstrating good discrimination(C-statistic:0.81),and calibration(Hosmer-Lemeshowχ^(2)=8.234,P=0.312).The prediction rule also showed adequate discriminative power(C-statistic:0.83)and calibration(Hosmer-Lemeshowχ^(2)=5.606,P=0.691)in the validation set.Three risk intervals were defined as low-,medium-,and high-risk groups.Conclusion:We derived and validated a 22-point risk score for POP following HVS,which may be useful in preventive interventions and risk management.Trial Registration:Chictr.org,ChiCTR1900028127;http://www.chictr.org.cn/showproj.aspx?proj=46932.
