Valvular heart surgery in Rajavithi hospital

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Valvular heart surgery in Rajavithi hospital

• Dr.WITTAWAT PIBUL
• Rajavithi Hospital

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• Valvular heart disease is the most common cardiac
  surgery in Thailand and also in Rajavithi
  hospital.

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Objective

• To review cases of valvular heart surgery in CVT
  unit, Rajavithi hospital in term of
• - patients characteristic
• - Pathology
• - Operative management
• - Morbidity, mortality

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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.

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Results

• Total of 441 cases
• 2006 143 cases
• 2007 160 cases
• 2008 138 cases

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Gender
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Age group
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Comorbidity
Comorbidity N()
Diabetes mellitus Hypertension Dyslipidemia Chronic kidney disease ( serum Cr gt2 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)
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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)
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Ejection fraction
EF N ()
Poor (lt30) Fair (30-50) Good (gt50) Not measure 9 (2.1) 59 (13.3) 350 (79.4) 23 (5.2)
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Coronary angiography

• CAG when male gt 45 years
• female gt 50 years
• or had CAD risk factor

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Result CAG

• CAG 180 cases
• Abnormal CAG 23 cases (13)

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Abnormal CAG by age groups
AGE Abnormal CAG No. CAG case abnormal CAG
lt 50 years 51-60 years 61-70 years 71-80 years gt 80 years 0 6 12 4 1 13 89 46 27 5 0 6.7 26.1 14.8 20
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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)

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Rheumatic heart disease

• 297 cases (67)
• Male 118 cases, female 179 cases

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• Mean age was 45 years

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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)
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Valve involvement
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Operative management

• MV Replacement 231 cases
• AV Replacement 94 cases
• MV Repair 20 cases
• Combine TV Repair 10 cases

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Choice of prosthetic valve replacement
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Degenerative calcification group

• 28 Male, 30 Female
• Mean age 62years
• Valve involvement

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• Operation Valve replacement
• Choice of prosthetic valve replacement

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Degenerative MR group

• 22 Male, 14 Female
• Mean age was 56 years
• Operation
• - Valve replacement 23 cases
• - Valve repair 13 cases

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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
• -AVMV 4 cases

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• Operation Valve replacement
• Choice of prosthetic valve

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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)

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• 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

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• Predicted mortality rate by EuroSCORE - 4.1
• LOS 15 days
• Post operative LOS 11.23 days

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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.

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THANK YOU