Early outcomes and analysis of factors influencing in-hospital mortality after concomitant heart valve replacement and coronary artery bypass grafting

ZHENG Hai-yun; WU Hao; HE Xiao-ling; ZHU Ping

摘要：Background Objective:To investigate the perioperative precautions,surgical methods and early clinical effi-cacy of patients with valvular heart disease complicated by coronary atherosclerotic heart disease treated with coro-nary 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 ef-fectiveness and statistical perioperative patient mortality.After integrating the SinoSCORE 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 analy-sis,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 suc-cessfully 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 un-derwent 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 com-bined 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 dia-stolic function of the majority of patients with valvular heart disease and coronary atherosclerotic heart disease im-proved 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 indepen-dent risk factors for in-hospital death in patients receiving CABG valve replacement.