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