Jin Lei, Zhang Guan-Xin, Han Lin, Wang Chong
Department of Cardiovascular Surgery, Changhai Hospital, Second Military Medical University, Shanghai, China.
Department of Cardiac Surgery, Shanghai Chest Hospital, Shanghai Jiaotong University, Shanghai, China.
Heart Surg Forum. 2019 Dec 17;22(6):E486-E493. doi: 10.1532/hsf.2369.
To compare baseline and outcome characteristics of multiple valve surgery with single-valve procedures in a multicenter patient population of mainland China.
From January 2008 to December 2012, data from 14,322 consecutive patients older than 16 years who underwent heart valve surgery at five cardiac surgical centers (except pulmonary valve operations) were collected. The patients were divided into seven subgroups according to the type of valve procedures, and baseline characteristics and postoperative outcomes were contrasted between all seven combinations of single-valve and multiple-valve procedures involving aortic, mitral, and tricuspid valves. Two independent logistic regression analyses were performed and multivariable risk factors for mortality were compared, with emphasis on single-valve versus multiple-valve surgery.
Baseline characteristics for MUV procedures (n = 8945) shared many differences to those for single-valve procedures (n = 5377). Proportion of females, chronic obstructive pulmonary disease, cerebrovascular disease, renal impairment, congestive heart failure, NHYA class III-IV, atrial fibrillation, pulmonary hypertension, and decreased ejection fraction were more common in MUV subgroups, and smoker, hypertension, dyslipidemia, active infectious endocarditis, and coronary bypass graft was less frequent. In-hospital mortality was higher for MUV as compared with single-valve procedures (2.4% versus 1.6%, P = .007). Preoperative independent predictors for mortality of patients undergoing MUV procedures were age, chronic obstructive pulmonary disease, diabetes mellitus, renal dysfunction, dialysis, congestive heart failure, cardiogenic shock, NYHA class III-IV, mitral stenosis, tricuspid regurgitation, mitral valve replacement, and concomitant CABG. However, risk factors for mortality were relatively different between single-valve and MUV procedures.
Baseline characteristics and epidemiology were different between MUV and single-valve procedures. The in-hospital mortality and postoperative complications for MUV procedures remained considerably higher and determinants of mortality were relatively different across procedures types. These findings serve as a benchmark for further studies, as well as suggest a continued search for explanations of MUV outcomes.
比较中国大陆多中心患者群体中多瓣膜手术与单瓣膜手术的基线特征和结局特征。
2008年1月至2012年12月，收集了5个心脏外科中心14322例年龄大于16岁且接受心脏瓣膜手术（不包括肺动脉瓣手术）的连续患者的数据。根据瓣膜手术类型将患者分为7个亚组，对比涉及主动脉瓣、二尖瓣和三尖瓣的单瓣膜与多瓣膜手术的所有7种组合之间的基线特征和术后结局。进行了两项独立的逻辑回归分析，并比较了死亡率的多变量风险因素，重点是单瓣膜手术与多瓣膜手术。
多瓣膜手术（n = 8945）的基线特征与单瓣膜手术（n = 5377）有许多差异。女性比例、慢性阻塞性肺疾病、脑血管疾病、肾功能损害、充血性心力衰竭、纽约心脏协会III-IV级、心房颤动、肺动脉高压和射血分数降低在多瓣膜亚组中更为常见，而吸烟者、高血压、血脂异常、活动性感染性心内膜炎和冠状动脉搭桥术则较少见。与单瓣膜手术相比，多瓣膜手术的住院死亡率更高（2.4%对1.6%，P = 0.007）。多瓣膜手术患者术前死亡的独立预测因素为年龄、慢性阻塞性肺疾病、糖尿病、肾功能不全、透析、充血性心力衰竭、心源性休克、纽约心脏协会III-IV级、二尖瓣狭窄、三尖瓣反流、二尖瓣置换术和同期冠状动脉搭桥术。然而，单瓣膜手术和多瓣膜手术的死亡风险因素相对不同。
多瓣膜手术和单瓣膜手术的基线特征和流行病学不同。多瓣膜手术的住院死亡率和术后并发症仍然相当高，且不同手术类型的死亡决定因素相对不同。这些发现为进一步研究提供了基准，也表明需要继续寻找多瓣膜手术结局的解释。
