Risk factors of early in-hospital death in patients with severe valvular disease after valve replacement

HOU Yan-juan; SHEN Ming-jing; CAI Li-chun; ZHOU Yan-ling

doi:10.3969/j.issn.1674-4055.2016.05.26

Abstract：Objective To analyze the risk factors of early in-hospital death in patients with severe valvular disease after valve replacement, and draw up corresponding preventive countermeasures. Methods The patients (n=168, male 70, female 98, aged from 35 to 76 and average age=47.3±6.8) were chosen from Jan. 2011 to Dec. 2014. All patients were divided, according to outcomes, into death group (n=8) and cured group (n=160). Before the replacement operation, the indexes of left atrial diameter (LAD), left ventricular end-diastolic inner diameter (LVEDd), left ventricular ejection fraction (LVEF) and cardio-thoracic proportion were detected by using iE33 Philips ultrasonic diagnostic apparatus. The durations of valve replacement, cardiopulmonary bypass (CPB) and aortic clamp were measured during the operation. Results Among all patients, there were 8 died early after the operation and mortality was 4.76%, and 160 cured and cure rate was 95.24%. The percentages of patients with body weight≥70 kg, preoperational LAD≥70 mm, CPB duration≥160 min and aortic clamp duration≥120 min increased in death group compared with those in cured group (all P<0.05). The multi-factor analysis showed that body weight≥70 kg (OR=4.372, 95%CI: 1.424-14.955), LAD≥70 mm (OR=1.592, 95%CI: 1.224~2.142) and aortic clamp duration≥120 min (OR=10.227, 95%CI: 3.781~28.792) were independent factors of early postoperative death. Conclusion Clinical physicians should pay more attention to the body weight, pre-operation LAD and aortic clamp duration during operation, and reduce postoperative mortality in patients with severe valvular disease.