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EuroSCORE模型对心瓣膜手术患者死亡风险的预测

目的 评价欧洲心脏手术风险评估系统（European System for Cardiac Operative Risk Evaluation,EuroSCORE）模型预测行心脏瓣膜手术患者在院死亡率的准确性。 方法 收集1998年1月至2008年12月于第二军医大学长海医院因心脏瓣膜疾病行外科治疗4 155例患者的临床资料，其中男1 955例，女2 200例；年龄45.90±13.64岁。先按additive及 logistic uroSCORE两种方法评分，将患者分为低风险（n=981）、中风险（n=2 492）、高风险（n=682）3个亚组，比较全组及各亚组患者的实际与预测死亡率。模型预测的校准度用HosmerLemeshow卡方检验，预测的鉴别度采用受试者工作特征（receiver operating characteristic，ROC）曲线下面积检验。 结果  4 155例患者在院死亡205例，实际在院死亡率4.93%；additive EuroSCORE预测死亡率为3.80%，而logistic EuroSCORE为3.30%；提示两种评分方法均低估了实际在院死亡率（χ2=11.13， 44.34，Plt;0.05）。additive EuroSCORE对高风险亚组在院死亡预测校准度较高（χ2=361，P=0.31），但对低风险亚组（χ2=0.00，Plt;0.01）及中风险亚组（χ2=14.72，Plt;0.01）较低；而logistic EuroSCORE对低风险亚组（χ2=1.66，P=0.88）及高风险亚组（χ2=11.71，P=0.11）在院死亡预测准确性均较高，却低估了中风险亚组（χ2=17.48，Plt;0.01）的实际在院死亡率。两种评分方法对全组患者在院死亡预测的鉴别度均较差（ROC曲线下面积分别为0.676和0.677）。 结论 EuroSCORE模型对本中心心瓣膜手术患者死亡风险预测的准确性较差，不适合本中心心瓣膜手术的风险预测，在今后的临床实践中应慎重使用。

心脏瓣膜手术的百年坚持与探索—2023亚洲心脏瓣膜中国论坛纪要

先天性心脏病合并感染性心内膜炎的外科治疗

目的 总结先天性心脏病（congenital heart disease，CHD）合并感染性心内膜炎（infective endocarditis，IE）的外科治疗经验，以提高诊断、治疗效果。 .方法 .回顾性分析我院73例CHD合并IE患者行瓣膜手术的临床资料，对30例主动脉瓣感染性心内膜炎者行主动脉瓣置换术，另3例行Ross手术。在IE累及二尖瓣21例患者中，行二尖瓣成形术5例，二尖瓣置换术16例；10例主动脉瓣、二尖瓣IE行双瓣膜置换术；对6例肺动脉瓣IE患者行单瓣法做肺动脉瓣成形术2例，肺动脉瓣置换术4例，其中1例同期行主动脉弓置换；3例三尖瓣IE均行三尖瓣置换术。结果 主动脉瓣感染33例(45.2％)，二尖瓣感染21例(28.8％)，肺动脉瓣感染6例(8.2％)，双瓣膜感染10例(13.7％)，三尖瓣感染3例(4.1％)。血培养及赘生物培养总阳性率为23.3％，其中链球菌8例（47.1％），葡萄球菌3例（17.6％）。本组无手术死亡，除1例二尖瓣置换术后1年再次发生IE，拒绝手术治疗外，其余72例患者随访1年均治愈。 结论 CHD应尽早行根治性手术，以避免远期并发IE，损坏心脏瓣膜。对CHD合并IE出现瓣膜关闭不全者应尽快手术，如IE累及二尖瓣、三尖瓣且无瓣膜结构的严重损毁者，施行瓣膜成形术是较好的方法。

老年患者二尖瓣置换同期行冠状动脉旁路移植术的临床分析

目的 总结老年二尖瓣疾病合并冠心病患者心瓣膜置换术同期行冠状动脉旁路移植术（CABG）的经验，以提高临床效果。 方法 2002年7月至2004年7月我科共30例老年二尖瓣疾病患者二尖瓣置换术同期行CABG。年龄66.0±9.1岁（60～73岁）, 4例为风湿性瓣膜病变,26例为二尖瓣瓣膜退行性病变。术前心功能分级(NYHA):Ⅰ级3例,Ⅱ级5例,Ⅲ级17例,Ⅳ级5例。共移植旁路血管71支,使用左侧乳内动脉24例，其余均为大隐静脉。置换机械瓣27例，置换生物瓣3例；行三尖瓣De Vega成形术17例。 结果 术后早期死亡1例(3.3%)。随访29例，平均随访时间13个月,心功能均有明显改善,Ⅰ级18例，Ⅱ级10例，Ⅲ级1例，可从事简单的运动及正常家务劳动，生活质量满意。 结论 老年二尖瓣疾病患者二尖瓣置换术同期行CABG的危险性较大，充分的术前准备，正确的手术方案，术中良好的心肌保护及严密的术后处理是手术成功的重要因素。

Combined Cardiac Valve Surgery and Coronary Artery Bypass Grafting： Report of 81 Cases

Objective To retrospectively review the clinical experience and early surgical results of combined cardiac valve surgery and coronary artery bypass grafting （CABG）. Methods From Jan. 2000 to Dec. 2005, combined valve surgery and CABG was performed in 81 patients. 37 patients were rheumatic heart disease with coronary stenosis, and 44 patients were coronary artery disease with valvular dysfunction. Single vessel disease was in 18 patients, two vessels disease in 9 and triple-vessel disease in 54. All the patients received sternotomy and combined valve surgery and CABG under cardiopulmonary bypass. Mitral valve repair and CABG were done in 26 patients. Valve replacement and CABG were done in 55 patients with 49 mechanical valves and 16 tissue valves. Four patients had left ventricular aneurysm resection concomitantly. The number of distal anastomosis was 3.12 5= 1.51 with 66 left internal mammary arteries bypassed to left anterior descending. Post-operative intra-aortic balloon pump was required in 4 cases for low cardiac output syndrome. Results Two patients died of low cardiac output syndrome with multiple organs failure. 79 patients had smooth recovery and discharged from hospital with improved heart function. 64 patients had completed follow-up with 5 late non cardiac related death in a mean follow-up period of 14.2 months. Conclusion Combined one stage valve surgery and CABG is effective with acceptable morbidity and mortality.

Perioperative results of cardiac valve surgery in patients with asymptomatic SARS-CoV-2 infection

ObjectiveTo analyze the perioperative outcomes of cardiac valve surgery in patients with asymptomatic SARS-CoV-2 infection. MethodsThe perioperative clinical data of patients receiving heart valve replacement in the Department of Cardiovascular Surgery, the First Affiliated Hospital of University of Science and Technology of China from November 2022 to February 2023 were retrospectively analyzed. According to whether the patients were infected with SARS-CoV-2, they were divided into a non-infected group and an asymptomatic group. The perioperative data of the patients were compared between the two groups, and the effect of asymptomatic infection on the result of heart valve replacement surgery was analyzed. ResultsA total of 66 patients were enrolled including 36 males and 30 females with a mean age of 58.0±11.1 years. There were 51 patients in the non-infected group and 15 patients in the asymtomatic group. There were 2 patients of mitral valve replacement, 20 patients of aortic valve replacement, 1 patient of double valve replacement, 3 patients of aortic valve replacement with tricuspid valvoplasty, 22 patients of mitral valve replacement and tricuspid valvoplasty, 18 patients of double valve replacement and tricuspid valvoplasty. Asymptomatic infected patients received more emergency surgery than uninfected patients (26.7% vs. 0.0%, P<0.01). There was no statistical difference in the duration of extracorporeal circulation, aortic occlusion, mechanical ventilation time after the surgery, ICU stay, postoperative drainage volume, or postoperative complications between the two groups. ConclusionPerioperative results of cardiac valve surgery in patients with asymptomatic SARS-CoV-2 infection and non-infection are almost the same.

Effect of remote ischemic preconditioning on preoperative heart rate variability in patients undergoing heart valve surgery: A randomized controlled trial

Objective Explore the effect of remote ischemic preconditioning (RIPC) on preoperative heart rate variability in patients with heart valves. Methods From January 2022 to July 2022, screening was conducted among 118 patients based on inclusion/exclusion criteria. Fifty-eight patients were excluded, and 60 patients participated in this trial with informed consent and were randomly divided into a RIPC group (n=30) and a control group (n=30). Due to the cancellation of surgery, HRV data was missing. 7 patients in the control group were excluded, and 5 patients in the RIPC group were excluded, 23 patients in the final control group and 25 patients in the RIPC group were included in the analysis. Comparison of relevant indicators of heart rate variability (standard deviation of NN interval (SDNN), standard deviation of mean value of NN interval in every five minutes (SDANN), mean square root of difference between consecutive NN intervals (RMSSD), percentage of adjacent RR interval>50 ms (PNN50), low frequency component (LF), high frequency component (HF) and LF/HF) at 8 hours in the morning on the surgical day between two groups of patients. Results There was no statistical difference in baseline characteristics between the two groups, and there was no significant difference in heart rate variability 24 hours before intervention (P>0.05). After the intervention measures were taken, the comparison of the results of heart rate variability at 8 hours on the day of operation showed that SDNN and SDANN of patients in the RIPC group were higher than those in the control group, with statistical differences (P<0.05). Conclusion RIPC can stabilize the preoperative heart rate variability of patients undergoing cardiac valve surgery.

Risk prediction models for acute kidney injury after cardiac valve surgery: A systematic review and meta-analysis

Objective To systematically evaluate the research quality and efficacy of prediction models for acute kidney injury (AKI) after heart valve surgery, screen key predictive factors, and provide evidence-based basis for clinical risk assessment. Methods Computer search was carried out in PubMed, Web of Science, EMBASE, Cochrane Library, Medline, China Biology Medicine Database, China National Knowledge Infrastructure, Wanfang Database, and VIP Database to collect studies on AKI prediction models after heart valve surgery published from January 2015 to July 2025. The PROBAST tool was used to evaluate the bias risk and applicability of the models, and the TRIPOD was used to assess the reporting quality. Meta-analysis was performed to integrate the effect sizes of high-frequency (≥3 times) predictive factors. Results A total of 24 studies (39 models) were included. Area under the curve (AUC) of the receiver operational characteristic curve was between 0.551 and 0.928, and the combined AUC was 0.77 (95%CI 0.72-0.82). The overall bias risk of the models was relatively high (100% of the studies had a high bias risk), only 2 studies conducted external validation, and the models in 10 studies were not validated. In terms of TRIPOD reporting quality, the overall reporting quality of 24 studies was low, with a compliance percentage (number of items) ranging from 36.36% to 77.27%. Meta-analysis showed that age (OR=1.041, P=0.006), diabetes (OR=1.64, P=0.001), hypertension (OR=2.529, P <0.001), blood transfusion (OR=1.49, P=0.001), cystatin C (OR=2.408, P=0.018), history of cardiac surgery (OR=2.585, P <0.001), atrial fibrillation (OR=1.33, P <0.001), and vascular complications (OR=1.22, P=0.008) were independent risk factors for postoperative AKI. Conclusion The clinical applicability of existing prediction models is limited, with high bias risk and low reporting quality, and the methodology needs to be optimized. Eight factors such as age and hypertension can be used as core indicators for postoperative AKI risk assessment. In the future, multicenter prospective studies should be carried out to develop more reliable prediction tools.

Validation of European System for Cardiac Operative Risk Evaluation in Heart Valve Surgery of Uyghur Patients and Han Nationality Patients

ObjectiveTo assess the accuracy of European System for Cardiac Operative Risk Evaluation (EuroSCORE) model in predicting the in-hospital mortality of Uyghur patients and Han nationality patients undergoing heart valve surgery. MethodsClinical data of 361 consecutive patients who underwent heart valve surgery at our center from September 2012 to December 2013 were collected, including 209 Uyghur patients and 152 Han nationality patients. According to the score for additive and logistic EuroSCORE models, the patients were divided into 3 subgroups including a low risk subgroup, a moderate risk subgroup, and a high risk subgroup. The actual and predicted mortality of each risk subgroup were studied and compared. Calibration of the EuroSCORE model was assessed by the test of goodness of fit, discrimination was tested by calculating the area under the receiver operating characteristic (ROC) curve. ResultsThe actual mortality was 8.03% for overall patients, 6.70% for Uyghur patients,and 9.87% for Han nationality patients. The predicted mortality by additive EuroSCORE and logistic EuroSCORE for Uyghur patients were 4.03% and 3.37%,for Han nationality patients were 4.43% and 3.77%, significantly lower than actual mortality (P<0.01). The area under the ROC curve of additive EuroSCORE and logistic EuroSCORE for overall patients were 0.606 and 0.598, for Han nationality patients were 0.574 and 0.553,and for Uyghur patients were 0.609 and 0.610. ConclusionThe additive and logistic EuroSCORE are unable to predict the in-hospital mortality accurately for Uyghur and Han nationality patients undergoing heart valve surgery. Clinical use of these model should be considered cautiously.

Protecting Effect of Remote Ischemic Preconditioning on Myocardium in Cardiac Valve Surgery

ObjectiveTo investigate whether there is a protecting effect of remote ischemic preconditioning (RIPC) on patients underwent cardiac valvular surgery. MethodWe retrospectively analyzed the clinical data of 72 adult patients underwent cardiac valvular surgery in our hospital from Febuary 2014 through April 2015 year. There were 26 males and 46 females with an age ranging from 23-68 years. We devided 72 patients into a RIPC group and a control group. There were 14 males and 28 females with a mean age of 48.87±12.28 years in the RIPC group. After the induction of anesthesia, the RIPC group was induced by three cycles of right upper limb ischemia and reperfusion using a blood pressure cuff. The blood pressure cuff was inflated to 200 mm Hg and we held it on for 5 minutes, deflated to 0 mm Hg and maintained for 5 minutes, which was defined as one cycle. There were 10 males and 20 females with a mean age of 47.70±8.07 years in the control group. We placed a standard blood pressure gasbag on the right upper limb for 30 minutes without inflation in the control group. We recorded the clinical data including cardiopulmonary bypass (CPB) time, the cross-clamping time of ascending aorta, preoperative ejection fraction (EF), EF after discharging, postoperative complica-tion and mortality. Blood were sampled preoperatively (T0), 30 minutes after RIPC (T1), 30 minutes aftr the cardiopul-monary bypass finished (T2), 24 hours (T3), 48 hours (T4) and 72 hours (T5) after surgery to detect the concentration of troponin T (cTnT) and creatine kinase-MB (CK-MB). We counted the person-time used dopamine and norepinephrine. ResultThere was no death in both groups. The mechanical ventilation time, the time of ICU stay, the time of hospital stay, the number of person used vasoactive agent, and the EF when discharging showed no statistical difference between the two groups. Levels of cTNT in the RIPC group were statistically lower than those in the control group at T2 and T3 (P=0.001, P=0.001). Levels of CK-MB in the RIPC group were statistically lower than those in the control group at T2, T3, and T4 (P=0.011, P=0.010, P=0.033). ConclusionRIPC may have protective effect on myocardium for patients underwent cardiac valvular surgery.