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Valvular heart surgery in Rajavithi hospital
Dr.WITTAWAT PIBUL
Rajavithi Hospital
Valvular heart disease is the most common cardiac surgery in Thailand and also in Rajavithi hospital.
Objective
To review cases of valvular heart surgery in CVT unit, Rajavithi hospital in term of
- patient’s characteristic
- Pathology
- Operative management
- Morbidity, mortality
Method
Reviewing database of valvular heart surgery in Rajavithi hospital from 1 Jan 2006 – 31 Oct 2008.
Reviewing medical records of morbidity and mortality cases.
Results
Total of 441 cases 2006 = 143 cases 2007 = 160 cases 2008 = 138 cases
Gender
7077
49
73
8389
143
160
138
0
20
40
60
80
100
120
140
160
180
2006 2007 2008 year
Male
Female
Total
Age group
12 13
32
35
58
32
12
2
6
30
53
57 56
21
18
4
0
10
20
30
40
50
60
70
11--20 21--30 31--40 41--50 51--60 61--70 71--80 >80 year
NO.
Male
Female
Comorbidity
Comorbidity N(%)
Diabetes mellitus
Hypertension
Dyslipidemia
Chronic kidney disease ( serum Cr >2 mmol/dL)
Stroke history
- full recovery
- residual weakness
29 (6.6%)
79 (17.9%)
67 (15.2%)
15 (3.4%)
10 (2.3%)
1 (0.2%)
NYHA
NYHA N (%)
NYHA Class I
NYHA Class II
NYHA Class III
NYHA Class IV
9 (2.1%)
134 (30.4%)
267 (60.5%)
31 (7%)
Ejection fraction
EF N (%)
Poor (<30%)
Fair (30-50%)
Good (>50%)
Not measure
9 (2.1%)
59 (13.3%)
350 (79.4%)
23 (5.2%)
Coronary angiography
CAG when male >= 45 years
female >= 50 years
or had CAD risk factor
Result CAG
CAG = 180 cases Abnormal CAG =23 cases (13%)
Abnormal CAG by age groups
AGE Abnormal CAG
No. CAG case
% abnormal
CAG
< 50 years
51-60 years
61-70 years
71-80 years
> 80 years
0
6
12
4
1
13
89
46
27
5
0%
6.7%
26.1%
14.8%
20%
Pathology of valvular heart disease
Rheumatic heart disease 297 cases (67%) Degenerative calcification 58 cases (13%) Degenerative MR 36 cases (8%) Infective endocarditis 26 cases (6%)
- Active IE 17 cases
- Healed IE 9 cases Other (congenital, ischemia 7 cases (2%)
annuloaortic ectasia)
Rheumatic heart disease
297 cases (67%) Male 118 cases, female 179 cases
Mean age was 45 years
Rheumatic heart disease by age groups
911
2426
29
17
2 24
25
4243 43
12
6
2
0
5
10
15
20
25
30
35
40
45
50
11--20 21--30 31--40 41--50 51--60 61--70 71--80 >80 year
NO.
Male
Female
NYHA of RHD patients
NYHA N (%)
NYHA Class I
NYHA Class II
NYHA Class III
NYHA Class IV
4(1.3%)
101 (34%)
176 (59.3%)
16 (5.4%)
Valve involvement
MV, 201, 68%
AV, 45, 15%
MV+AV, 51, 17%
MV
AV
MV+AV
Operative management
MV Replacement 231 cases AV Replacement 94 cases MV Repair 20 cases Combine TV Repair 10 cases
Choice of prosthetic valve replacement
Type of prosthetic mitral valve replacement in rheumatic heart disease
Ball-cage valve, 113, 49%
Bioprosthetic valve, 6, 3%
Bileaflet valve, 112, 48%
Type of prosthetic aortic valve replacement in rheumatic heart disease
Ball-cage valve, 10, 11%
Tissue valve, 5, 5%
Bileaflet valve, 79, 84%
Degenerative calcification group
28 Male, 30 Female Mean age 62years Valve involvement
MV, 7, 12%
AV, 47, 81%
MV+AV, 4, 7%
MV
AV
MV+AV
Operation :Valve replacement Choice of prosthetic valve replacement
Ball-cage valve, 16, 26%
Bioprosthetic valve, 5, 8%Bileaflet valve, 41,
66%
Degenerative MR group
22 Male, 14 Female Mean age was 56 years Operation
- Valve replacement 23 cases
- Valve repair 13 cases
Infective endocarditis group
15 male, 11 female Mean age was 41years. Valve involvement
-Prosthetic valve 10 cases
-AV 6 cases
-MV 4 cases
-Native valve 16 cases
-AV 6 cases
-MV 6 cases
-AV+MV 4 cases
Operation : Valve replacement Choice of prosthetic valve
Ball-cage valve, 8, 27%
Homograft, 2, 7%Bileaflet valve, 20,
66%
Result of operative management
Morbidity 43 cases
- Pneumonia 10 cases (2.27%)
- Acute renal failure
and need dialysis 6 cases (1.36%)
- Surgical wound infection 6 cases (1.36%)
- Post op bleeding and
need re operation 21cases (4.8%)
Mortality 21 case (4.8%)
- Low cardiac out put 11 cases
- Sepsis 5 cases
- Multi-organ failure 2 cases
- Arrhythmia 2 cases
- Thyroid crisis 1 cases
Predicted mortality rate by EuroSCORE - 4.1 % LOS 15 days Post operative LOS 11.23 days
Conclusion
The most common cause of valvular heart surgery in Rajavithi hospital was RHD.
Most of the patients had NYHA Class III. Most of the operative management was
valvular replacement. The most common choices of prosthetic
valve were Bileaflet and Ball cage valve. Morbidity and mortality rates were
acceptable.
THANK YOU