关键词:

心脏瓣膜置换术, J-Valve, 生物瓣衰败, 经导管瓣中瓣治疗, 术中护理

Abstract:

Objective　To summarize the early results and intraoperative nursing experiences of valve-in-valve implantation treatment with J-Valve interventional valve in patients with biovalvular decay in different valve positions. Methods　From April 2020 to August 2021, 39 patients who underwent valve-in-valve implantation treatment due to the decay of surgical biological valves in different valve positions in Guangdong Provincial People's Hospital were selected as the research subjects, including 19 males and 20 females, with an age of (72.6±10.8) years old, all of whom were treated with J-Valve interventional valve. Targeted intraoperative nursing plans were implemented, condition monitoring, safety nursing, and surgical nursing cooperation were strengthened, and effective nursing interventions were taken to urgently respond to intraoperative complications. The duration of treatment in intensive care unit (ICU) and hospital stay, postoperative complications such as stroke, permanent pacemaker implantation, and pericardial effusion, and nursing satisfaction during hospitalization were observed. Results　There were no deaths during surgery in 35 patients who underwent transcatheter mitral valve-in-valve implantation alone, 1 case had emergency thoracotomy due to interventional valve displacement to the left ventricle, 1 case had chest reopening to stop bleeding due to cardiac tamponade, and 1 case had mild left ventricular outflow tract obstruction. Except for 1 case who underwent craniotomy due to intracranial hemorrhage within 30 days after surgery, no cases developed complications of stroke, permanent pacemaker implantation, pericardial effusion, and readmission due to cardiogenic disease. Among the remaining 4 cases who did not have transcatheter mitral valve-in-valve implantation alone, 1 case with transapical aortic valve-in-valve implantation and 1 case with transatrial tricuspid valve-in-valve implantation successfully completed surgical treatment without intraoperative and postoperative complications. One case who underwent transapical mitral-aortic valve-in-valve implantation died of severe pulmonary hemorrhage and multi-organ failure 16 days after surgery. One case who underwent transapical mitral valve-in-valve implantation + transcatheter aortic valve replacement + mitral perivalvular leakage closure died of septic shock caused by fungal infection in the lungs 10 days after surgery. The statistical results of nursing satisfaction questionnaire during hospitalization were satisfactory. Conclusions　Mitral valve-in-valve implantation treatment with J-Valve interventional valve in high-risk patients with biovalvular decay has achieved good early clinical results, and can also be safely applied in the treatment of intravalvular valves with aortic or tricuspid valve decay, providing a new alternative to surgery for patients with biovalvular decay in different valve positions, but it is still necessary to be very cautious when performing multi-valve interventional surgery during the same period. In the process of surgical treatment, the implementation of scientifically based nursing plans can effectively prevent the complications, promote the early recovery, and improve the nursing satisfaction.

Key words:

Heart valve replacement, J-Valve, Biovalvular decay, Transcatheter valve-in-valve implantation, Intraoperative care