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[Expanding the surgical indication to the cases with high risk valve diseases]
N Kitamura1, T Miki, Y Fukushima
1Department of Cardiovascular Surgery, Osaka National Hospital, Japan.
Insights
This study details advancements in valve surgery for complex cases, including cardiac cachexia, narrow valvular annuli, and elderly patients. Novel techniques and therapies improve outcomes in challenging cardiac valve repair and replacement procedures.
Area of Science:
- Cardiovascular Surgery
- Medical Technology
- Critical Care Medicine
Context:
- Expanded indications for valve surgery over seven years.
- Focus on complex patient profiles and challenging surgical scenarios.
- Need for specialized techniques in valve repair and replacement.
Purpose:
- To present novel surgical techniques and therapeutic strategies for complex valve surgery cases.
- To evaluate the effectiveness of developed methods in improving patient outcomes.
- To address challenges in treating patients with cardiac cachexia, narrow valvular annuli, acute endocarditis, and advanced age with comorbidities.
Summary:
- Four hundred fifty-eight valve surgeries were performed, expanding indications to include cardiac cachexia, cases needing special techniques (narrow annuli, endocarditis), and elderly patients (≥70 years).
- Developed techniques include intrapulmonary artery balloon pumping (IPBP) for cardiac cachexia, Coupling Valve Grafting for narrow annuli, and Collared Prosthesis for endocarditis.
- Intravenous hydration (IVH) therapy pre-surgery showed effectiveness in patients with low liver and respiratory function. Elderly patients with severe liver dysfunction (ICG >40%, bilirubin >3 mg/dL) face high mortality (60%) due to potential multi-organ failure (MOF).
Impact:
- Demonstrates successful application of innovative surgical techniques in high-risk valve surgery patients.
- Highlights the importance of tailored therapeutic approaches for specific complex cardiac conditions.
- Identifies critical risk factors, particularly severe liver dysfunction in elderly patients, guiding future management strategies and research priorities in cardiac surgery.
Abstract:
Four hundred and fifty eight cases of valve surgery were performed at this institution over the past 7 years, during which the surgical indication has been gradually expanded to cases of three types. The first type is serious disease complicated by cardiac cachexia; in these cases, in addition to the aggressive use of IABP, we also use the intrapulmonary artery balloon pumping (IPBP) technique we developed. IVH therapy for two months before surgery has been especially effective and given good results to cases with low liver function and low respiratory function. The second type consists of cases necessitating special surgical technique, for example, cases with very narrow valvular annuli and cases complicated by acute endocarditis. Good results have been obtained in the former with a new technique that we developed, called "Coupling Valve Grafting", and in the latter with a technique of "Collared Prosthesis". The third type is elderly patients aged 70 years or more. In particular, the greatest problem now seems to lie in low liver function of which ICG (15 min) is higher than 40% and total serum bilirubin is over 3 mg/dl; in these cases, progression to MOF is frequent and the patient's life is saved in only 40% of cases.