Prevalence of Preoperative Anemia in Elective Rheumatic Valve Surgery at a Tertiary Care Center in Nepal

Background: Rheumatic Valvular Heart disease (RVHD) is common in developing countries often associated with anemia;however its burden is often overlooked. Anemic patients undergoing surgery are likely to receive blood transfusion, increasing morbidity and mortality. Prevalence of anemia in cardiac surgical patients are studied extensively, however its burden in RVHD is lacking. This study attempted to investigate the prevalence of preoperative anemia in RVHD and its effect on blood transfusion, morbidity and mortality in patients undergoing valve surgery. Methods: This is a retrospective observational study conducted at a tertiary care hospital in Nepal. We considered 340 patients who underwent Rheumatic valve replacement surgery from 2014 January to December 2016 and data on their socio-demographic and clinical characteristics were extracted from the patient’s records. The analyses meeting the study objectives were conducted using IBM SPSS v25 for Windows (IBM Statistical Package for Social Sciences, 2015IBM Corporation, New York, United States). Results: The prevalence of no anemia, mild, moderate, and severe anemia was 34.1%, 57.7%, 39.6%, 2.5%, respectively. The units of Red Blood Cell used for transfusion were 1.2 units, 2.0 units, 2.3 units, and 1.6 units in patients without anemia, and those with mild, moderate and severe anemia respectively. The incidence of reexploration was higher in patients with severe anemia as compared to the non anemic with an incidence of 66.6%. A proportion of the patients with no anemia, mild, moderate and severe anemia with less than 7 days stay in the intensive care unit were 89%, 82%, 84.7% and 100% respectively. The length of hospital stay more than 10 days was seen in 58.9%, 71.6%, 63% and 100% in patients with no anemia, mild, moderate and severe anemia. An overall incidence of mortality in anemic patients was 11% while in non anemic patients was 5.3%. Conclusions: The prevalence of anemia was high in the Nepalese patients with Rheumatic valvular heart disease planned for elective surgery. There was an increased incidence of blood transfusion, longer hospital stay, and increased mortality in anemic patients compared to their non anemic counterparts.

Outcomes of Ahmed valve surgery for refractory glaucoma in Dhahran, Saudi Arabia

AIM: To evaluate the outcomes of Ahmed glaucoma valve(AGV) implantation surgery for refractory glaucoma.METHODS: This one-armed historical cohort study was conducted in 2011. Refractory glaucoma was defined as eyes with an intraocular pressure(IOP) greater than21 mm Hg with maximally tolerated glaucoma medications, failed surgeries, or both. For all eyes with refractory glaucoma that underwent AGV implantation,data were collected on IOP, the best corrected visual acuity(BCVA) and glaucoma medications preoperatively and 4, 6, 12, 24 and 56 wk postoperatively. Logarithm values of IOP were calculated and compared. RESULTS: The study group was comprised of 30patients(30 eyes, 16 males and 14 females) with refractory glaucoma. Mean preoperative IOP was 39.3 ±13.8 mm Hg. Postoperative mean IOP was 15.7±7.1 mm Hg,19.6 ±12.8 mm Hg and 13.9 ±14.2 mm Hg at 12, 24 and56 wk respectively. BCVA was ≥6/60 in 11 eyes preoperatively, and five eyes had BCVA ≥6/60 at 56 wk postoperatively. Preoperatively, more than four medications were used to treat glaucoma in 21 eyes. At12 wk postoperatively, no medications were required to control IOP in 20 eyes. At 56 wk postoperatively, at least one medication was required to control IOP in 10 eyes.Over the entire follow up period, four eyes were treated with yttrium aluminium garnet(YAG) laser and 14 eyes required a second surgery. The AGV was removed in four eyes.CONCLUSION: AGV implantation reduced IOP and the number of medications required to control refractory glaucoma. However, there was a higher risk of decreased vision. Long-term follow up and prompt intervention are recommended.

Impact of MitraClip Program on the Volume and Outcomes of Mitral Valve Surgery:A Single-Center Retrospective Study

Surgical repair has been the standard therapy for severe mitral regurgitation causing symptoms or left ventricular dysfunction.Percutaneous mitral valve repair has become an appealing alternative approach for patients who are not suitable for surgery.However,clinical trial data are not available on the institutional impact of a percutaneous mitral valve repair program on mitral valve surgery.The current study retrospectively evaluated the impact of the MitraClip program on the mitral valve surgery volume and outcomes.Patient data were retrieved from the 2 years before and the 2 years after initiation of the MitraClip program.The volume of MitraClip procedures increased from eight cases in 2015 to 91 cases in 2017.Since the initiation of the MitraClip program in 2015,the volume of both mitral valve replacement and mitral valve repair also increased(43 vs.60 and 110 vs.154,respectively).Importantly,we observed improved surgical outcomes,including fewer perioperative complications and lower operative mortality and in-hospital mortality.Data from our single-institution experience indicate that the introduction of the MitraClip program is associated with increased mitral valve surgery volume and improved outcomes.The establishment of the MitraClip program enables the hospital to provide higher quality of care and potentially become a referring center for structural heart patients.

Mapping and ablation of atrial arrhythmia after valve surgery plus mini-maze procedure

Background Recurrent atrial arrhythmia is very common in patients after mitral valve surgery plus mini-maze procedure.Investigation about the mechanism for these patients may have important implication to improve the surgery strategy.Methods Mini-maze procedure was defined as follow: Pulmonary vein encircling incision and roof line connecting the two circles lesion,left atrial isthmus lesion,and the right atrial isthmus lesion.There were 517 patients with rheumatic valvular disease and pre-operative atrial fibrillation (AF) undergoing valve surgery plus mini-maze procedure in our hospital in the last 3 years,and 93 patients(18%) had recurrent atrial arrhythmia.Twelve patients(6 males and 6 females,mean age 53.8±7.8 ys) underwent electrophysiological study using 3-D mapping system(10 pts) or conventional mapping method(2 pts).Results The first recurrent time from surgery was 4.4±2.2 months.The mean follow-up time after catheter ablation was(12.0±6.0) months.One patient with sinus bradycardia had recurrent incessant atrial tachycardia (AT),but the AT was terminated by catheter position and never could be induced any more.She underwent a repeat procedure but failed just as the course in the first time, and was treated with DDDR pacemaker plus amiodarone.Six patients had 10 kinds of stable AT,including 5 at right atrial isthmus,2 at roof line,1 related to right atrial incision, 1 at anterior wall of left atrial,and 1 related to left superior pulmonary vene.All the stable AT were eliminated and remained sinus rhythm.Three patients had ATs with variable cycle length and the 3-D mapping suggested macro-reentry AT around mitral annulus.We tried to ablate at routine mitral isthmus and also in coronary sinus,but could not reach bi-directional conduction blocking.The other 2 patients were AF with reconnection at all previous ablation sites.Ablation strategy for AF included lesion at re-conduction sites and complex fractionated atrial electrogram.The patients with AF and mitral isthmus related AT were administrated with DC cardioversion and then took amiodarone.One AT and one AF recurred. Conclusions The recurrent atrial arrhythmia after mini-maze mostly related to reconnection at previous lesion sites and catheter ablation for AT could have a high success rate.It would be very hard to block mitral isthmus after valve replacement,so transmural lesion during surgery procedure is the most important strategy for preventing postoperative atrial arrhythmia.

Analyzing risk factors for postoperative acute renal failure requiring dialysis after valve surgery

Objective To evaluate risk factors for postoperative acute renal failure requiring dialysis (ARF-D) after hear valve surgery. Methods Adult patients (age≤18 years) underwent valve surgery with preoperative serum creati nine 【 300 μmol / L were included between January 2005 and December 2008. Fifty patients developed ARF-D

The Application Effect of Predictive Nursing on Cardiopulmonary Rehabilitation of Patients Undergoing Heart Valve Surgery with Extracorporeal Circulation

Objective:To evaluate the application effect of predictive nursing on patients undergoing heart valve surgery with extracorporeal circulation(ECC).Methods:92 ECC patients admitted to the hospital between July 2021 and July 2023 were selected and grouped by random number table method;the observation group practiced predictive nursing,while the reference group practiced conventional nursing.The cardiopulmonary rehabilitation and other indexes were compared between the groups.Results:The postoperative rehabilitation time of the observation group was shorter than that of the reference group,the treatment compliance was higher than that of the reference group,the cardiopulmonary function indexes were all better than that of the reference group,and the complication rate was lower than that of the reference group(P<0.05).Conclusion:The implementation of predictive nursing for ECC patients can promote postoperative rehabilitation,improve patients’treatment compliance,and enhance the cardiopulmonary rehabilitation effect,and nursing safety is high.

Live three-dimensional transesophageal echocardiography in mitral valve surgery

Background Live three-dimensional transesophageal echocardiography （live-3D-TEE） is a new technique, but its clinical value is unclear at present. This study aimed to investigate the feasibility, imaging quality and accuracy of live-3D-TEE for assessing mitral valve morphology to determine if live-3D-TEE has important value in mitral valve surgery.Methods Twenty-four patients with mitral valve disease （mean age （47.1±11.6） years, mean weight （64.7±10.5） kg） underwent live-3D-TEE and two dimensional transesophageal echocardiography （2D-TEE） before and after mitral valve surgery. Sensitivity, specificity, and total consistency rates of live-3D-TEE for diagnosing ruptured chordae were calculated and compared to surgeon＇s findings. We also compared the diagnostic accuracy of mitral valve disease between live-3D-TEE and 2D-TEE.Results Live-3D-TEE allowed visualization of the anatomic structure of the heart online and clearly identified the valvular apparatus and their defects. Sensitivity and specificity for the detection of ruptured chordae by live-3D-TEE were 87.5% and 100% respectively, and the total consistency rate was 95.8%. Additional defects not diagnosted by 2D-TEE were found in three cases （12.5%） preoperatively by live-3D-TEE. Live-3D-TEE could evaluate the function of prosthetic or native valves immediately after operation. One case was re-repaired （4.2%） using guidance by live-3D-TEE.Conclusion Live-3D-TEE enabled evaluation of mitral valve function and provided adequate valuable information before and after mitral valve surgery. We conclude that live-3D-TEE can play an important role in mitral valve surgery.

Is the European System for Cardiac Operative Risk Evaluation useful in Chinese patients undergoing heart valve surgery？

Background The European System for Cardiac Operative Risk Evaluation （EuroSCORE） is one of the most widely used risk models for the predicting mortality after cardiac surgery. The aim of this study was to validate the EuroSCORE model for predicting operative mortality in heart valve surgery on a Chinese multicenter database and comparing the performance of EuroSCORE with our new risk stratification system, the Sino System for Coronary Operative Risk Evaluation （SinoSCORE）. Methods Data from patients undergoing heart valve surgery between January 2007 and December 2008 were retrospectively collected, from 43 hospitals in China. The EuroSCORE and the SinoSCORE were calculated for each patient. Mortality was defined as any in-hospital death. Area under the receiver operating characteristics curve （AUC） was used to study the discriminatory abilities of the models. The Hosmer-Lemeshow （H-L） goodness-of-fit test was used to study the calibration of the predictive models. Results A total of 15 367 patients were analyzed. For the entire cohort, the observed mortality was 2.34%, the predicted mortality was 3.71% （additive）, 3.19% （logistic） and 3.66% （SinoSCORE）. AUC was 0.747 for SinoSCORE, 0.699 additive and 0.696 for logistic EuroSCORE. Calibration of SinoSCORE and additive EuroSCORE was good （H-L： P=-0.250 and P=0.051, respectively）, but the logistic EuroSCORE model had a poor calibration （H-L： P〈0.05）. The discriminatory ability and calibration of the SinoSCORE were good in low- and high-risk patients, However, the discriminatory ability of the EuroSCORE model was poor in all risk deciles. Conclusions The EuroSCORE does not accurately predict mortality in Chinese patients with heart valve surgery, and the SinoSCORE is superior to the EuroSCORE at predicting in-hospital mortality in Chinese heart valve surgery patients.

Clinical risk score for postoperative pneumonia following heart valve surgery

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.

Effect of prophylactic oral amiodarone on postoperative outcomes in patients with preoperative atrial fibrillation undergoing cardiac valve surgery for rheumatic heart disease

Background Atrial fibrillation（AF） is the most common arrhythmia in patients with rheumatic heart disease（RHD）. The impact of prophylactic oral amiodarone and total dosage on postoperative outcomes in RHD patients accompanied by AF after cardiac valve surgery（CVS） is still unknown. Methods This retrospective analysis was performed on a total of 562 RHD patients with preoperative permanent AF undergoing CVS. One hundred and thirty-five patients receiving preoperative oral amiodarone were in the amiodarone group, 427 patients with no exposure to amiodarone were in the control group. Data gathered included constitution of the surgical approaches, postoperative incidence of conversion from AF to sinus rhythm, low cardiac output, rapid AF and ventricular arrhythmias, mechanical ventilation time, length of ICU stay, length of hospital stay, and average ventricular rates in patients with AF at discharge. Results In the amiodarone group, 30 patients converted to sinus rhythm after surgery, the incidence（30/135, 22.2%） was higher than that in the control group（45/427, 10.5%, P 〈 0.05）. Compared with patients in the control group,incidence of rapid AF（19.3% vs 27.4%） and ventricular arrhythmias（6.7% vs 12.1%） in the amiodarone group were significantly lower（P 〈 0.05）. Length of ICU stay and hospital stay in the amiodarone group were significantly shorter than those in the control group（P 〈 0.05）. The sinus rhythm conversion rate of the patients with total dosage of above 10 g（14/43, 32.6%） was significantly higher than that of the patients receiving less than 10 g（16/92, 17.4%） amiodarone（P 〈 0.05）. Conclusions Prophylactic oral amiodarone increases postoperative sinus rhythm conversion rate in RHD patients with preoperative permanent AF after CVS, and shows a dose-response relationship with the conversion rate. It also reduces the incidences of tachyarrhythmia and ventricular arrhythmias, shortens ICU stay and hospital stay, thus improving the prognosis of those patients.

Vacuum sealing drainage technique in the treatment of poor healing wounds after heart valve surgery:experience in cardiac nursing

Background Poor wound healing or postoperative infection after open-heart surgery is most commonly seen. If not treated in time or the infection progresses, it can lead to sternal infection, even mediastinal and pericardial infection, causing a higher mortality rate. Vacuum sealing drainage （VSD） is a new technology to promote wound healing. We studied the use of VSD technique in poor wound healing after heart valve surgery to see if it could achieve good therapeutic efficacy. Methods From 2013 October to 2014 October in Guang- dong General Hospital, 86 cases of the application of vacuum sealing drainage technique in the treatment of cardiac nonunion after valve replacement in patients with nursing observation. The treatment time, death rate and infection rate, etc were compared. Results Wound healing time of 86 patients receiving vacuum sealing drainage was 14.6 ± 3.6 days, and no patient died. Two patients came back to hospital for repair due to dehis- cence of the incision after discharge. Conclusion Nursing observation and drainage management were the key of VSD. VSD technique is worthy to be popularized clinically.

Validation of four different risk stratification models in patients undergoing heart valve surgery in a single center in China

Background Several risk stratification models have been developed for cardiac surgery. This study aimed to evaluate the accuracy of four existing risk stratification models, the Fuwai System for Cardiac Operative Risk Evaluation （FuwaiSCORE）, the Society of Thoracic Surgeons 2008 cardiac surgery risk model for isolated valve surgery （the STS model）, the European System for Cardiac Operative Risk Evaluation （EuroSCORE） and the initial Parsonnet＇s score （the Parsonnet model） in predicting prolonged intensive care unit （ICU） stay in Chinese patients undergoing heart valve surgery. Methods Data were collected retrospectively from records of 1333 consecutive patients who received heart valve surgery in a single center between November 2006 and December 2007. Prolonged ICU stay was defined as not less than 124 hours. Calibration was assessed using the Hosmer-Lemeshow （H-L） goodness of fit test. Discrimination was assessed using the receiver-operating-characteristic （ROC） curve area. Results The FuwaiSCORE showed good calibration and discrimination compared with other risk models. According to the H-L statistics, the value of the FuwaiSCORE was 12.82, P 〉0.1. The area under ROC curve of the FuwaiSCORE was 0.81 （95%C/0.78-0.84）. Conclusions Our study suggests that the FuwaiSCORE is superior to the other three risk models in predicting prolonged length of ICU stay in Chinese patients with heart valve surgery. Having fewer variables, the system is much easier for bedside use than other systems.

Isolated Tricuspid Valve Repair and Right Atrial Plication Performed Using a Beating-Heart Technique for Atrial Functional Tricuspid Valve Regurgitation

Background: Isolated tricuspid valve disease remains a controversial indication for surgical intervention. Many patients referred for surgery already have a poor clinical condition and an advanced New York Heart Association functional class. There is no consensus on the optimal surgical technique for this condition, including on whether to perform the procedure on a beating or an arrested heart and whether to perform valve repair or replacement. Methods: We analyzed four case series between 2015 and 2022 in which patients with secondary tricuspid regurgitation (TR) underwent valve repair on a beating heart and right atrial plication for a dilated right atrium. The TRI-SCORE was calculated for each patient. Results: All patients experienced a favorable postoperative course with significant improvements in heart failure symptoms. TR was markedly reduced;however, in one patient with concomitant mitral regurgitation (MR) and a high TRI-SCORE, MR worsened postoperatively. This patient later died from unknown causes due to multiple comorbidities in the late phase. Conclusions: Tricuspid valve repair on a beating heart was effective for improving the cardiac function, and the TRI-SCORE proved useful as a preoperative risk assessment tool. The underlying mechanism by which TR exacerbates MR requires further investigation.

Is it the time to reconsider the choice of valves for cardiac surgery： mechanical or bioprosthetic？

Valvular heart disease is a pathologic process involving one or more of the four valves(aortic,pulmonary,mitral and tricuspid)of the heart typified by stenosis or regurgitation and leading to patient symptoms.The most common causes are tissue degeneration,rheumatic fever and congenital heart diseases.Aortic valve replacement(AVR)using either mechanical or bioprosthetic(tissue)valves via open-heart surgical

Severe prelenticular membrane formation on the surface of a hydrophilic acrylic intraocular lens after cataract surgery in an eye with an Ahmed valve implant

【正】Dear Sir,Iam Yong-Sun Ahn,from the Department of Ophthalmology of St.Vincent Hospital of Suwon,Kyungki-do,South Korea.Cataracts are a common problem in eyes with a glaucoma drainage device(GDD),because tube shunt surgery increases the incidence and progression of cataracts[1].An Ahmed valve,the most commonly inserted GDD,is composed of a silicone tube connected to a flat plate sewn to the sclera,and aqueous humor flows from the

Combined Surgical Treatment of Atherosclerotic Coronary Artery Disease and Moderate Aortic Valve Stenosis in Patient with Concomitant Lipton’s R-III Type of Single Coronary Artery Anomaly

A single coronary artery is a very rare condition,commonly associated with other congenital anomalies.It could be generally considered as neither benign nor malignant form of congenital coronary artery anomalies since its pathophysiological and clinical implications grossly depend on different anatomical patterns defined by the site of origin and distribution of the branches.By presenting the patient who underwent successful coronary artery bypass grafting and aortic valve replacement surgery in a presence of isolated single coronary artery,we intend to emphasize natural and procedural risks and distinguish casual from causal in this extremely rare clinical and surgical scenario.

Neonatal Marfan Syndrome: Improving the Bad Prognosis with a Strict Conservative Treatment with Carvedilol?

We report about a successful heart failure therapy with carvedilol in two children with neonatal Marfan syndrome (nMFS). As shown in Case 1, double valve replacement in an infant with neonatal Marfan syndrome is feasible but its benefit on long term is uncertain. Excluding our patient, 3 infants with nMFS from the literature died early after cardiac surgery. Our second case is a unique patient who survives nMFS despite diaphragmatic herniae, dilated neonatal cisterna magna and severe atrioventricular valve insufficiencies. Treated with 0.7 mg/kg/day Carvedilol since his seventh month of life, he never developed severe heart failure. However despite his good health status at the age of 9 years, a progressive aortic root dilatation and left conornary aneurysm are still waiting for surgical repair.

Infective Endocarditis-induced Crescentic Glomerulonephritis Dramatically Improved after Removal of Vegetations and Valve Replacement

Infective endocarditis （IE） is associated with poor prognosis and higher mortality. IE-induced glomerulonephritis, especially crescentic glomerulonephritis （IE-CGN） with renal dysfunction, is an independent risk factor for mortality For the treatment of IE-CGN, many therapeutic strategies including antibiotics alone, antibiotics combined with corticosteroid, immunosuppressive agents, plasmapheresis, or cardiac surgery have been applied and obtained various results.C21 Here, we reported a case of CGN with progressive renal failure secondary to IE in which the renal function was dramatically improved by the treatment of surgical valve replacement and antibiotics.

A Seven-year Experience for The Surgical Radiofrequency Ablation in Patients With Atrial Fibrillation

Objective A 7-year experience for the treatment strategy using mono- and bi-polar radiofrequency （RF） ablation procedures in a heterogeneous group of patients was reported. Methods Between July 2003 and May 2009, the data of 314 consecutive patients aged 13 -75 （48.70 ± 11.09 ）undergone the radiofrequency ablation procedure for atrial fibrillation （AF） associated with concomitant cardiac surgery were analyzed. Monopolar was used for 91 patients; Medtronic bi-polar RF ablation procedure for 92 patients and Atricure RF ablation procedure for 131 patients. All patients were combined with valve surgery. Regular follow-ups were performed at 3, 6 month after surgery. Results Hospital mortality after combined open heart and surgical RF ablation was 0 %. The success rates for sinus rhythm conversion with monopolar RF were 73.6 % immediately, 74. 7 % at 3 months, 79. 1% at 6 months ; with Medtronic bi- polar RF, the rates were 78.3 % immediately, 82. 8 % at 3 months, 84 % at 6 months ; with Atricure bi-polar RF, the rates were 82. 4 % immediately, 84. 1% at 3 months, 83.9 % at 6 months. Conclusions The use of RF ablation procedures is a safe and efficient option to cure AF during open heart surgery in a selective group of patients.

The prognostic role of postoperative serum creatinine(within 24 hours)for in-hospital and one-year mortality in middle-aged and aged patients with rheumatic heart disease

Background Increased serum creatinine(SCr)was common after cardiac surgery and associated with poor outcomes.However,the prognostic role of postoperative SCr level measured on the morning of the first day was unclear in middle-aged and aged patients with rheumatic heart disease(RHD)undergoing valve replacement surgery(VRS).Methods Consecutive middle-aged and aged patients(age≥45 years)diagnosed with RHD undergoing at least one valve replacement were enrolled.Patients were routinely taken into the intensive care unit(ICU)for special care within 1 hour after VRS.SCr was measured at ICU admission and on the first day morning(within 24 hours).Association of postoperative SCr level with in-hospital and one-year mortality was analyzed.Results 3919 patients were finally included and divided into 4 groups according to the quartiles of postoperative SCr level on the first day morning:<1.0 mg/d L(n=1064),1.0-1.2 mg/d L(n=892),1.2-1.5 mg/d L(n=956)and≥1.5 mg/d L(n=1007).SCr level measured on the first day morning following surgery was an independent predictor for in-hospital mortality(adjusted OR:3.42,95%CI:2.52-4.63,P<0.001)and 1-year mortality(adjusted HR:2.99,95%CI:2.32-3.86,P<0.001).SCr level measured at this time had a greater predictive power for inhospital mortality than that measured at the time of ICU admission after surgery(P<0.001).Cumulative one-year mortality was significantly higher in patients with upper postoperative SCr quartiles on the first day morning(Logrank:125.75,P<0.001).Conclusions Postoperative SCr level measured on the first day morning could serve as an early and powerful prognostic marker for in-hospital and one-year mortality in middle-aged and aged RHD patients undergoing VRS.Attention should be paid to RHD patients with increased postoperative SCr level within24 hours after surgery.