Effect of Combined Etomidate-Ketamine Anesthesia on Perioperative Electrocardiogram and Postoperative Cognitive Dysfunction of Elderly Patients with Rheumatic Heart Valve Disease Undergoing Heart Valve Replacement

Objective. To explore the effect of combined etomidate-ketamine anesthesia on perioperative electrocardiogram (ECG) and postoperative cognitive dysfunction (POCD) of elderly patients with rheumatic heart valve disease (RHVD) undergoing heart valve replacement. Methods. The data of 100 elderly RHVD patients treated in our hospital from May 2019 to May 2020 were selected for the retrospective analysis, and by adopting the double-blind method, the patients were divided into the ketamine group (n = 50) and the combined group (n = 50) according to the anesthesia methods. During the induction of anesthesia, the patients of the two groups were given a small dose of ketamine (0.5 mg/kg) at 5 μg/kg/min continuously via pump injection until the end of surgery, and on this basis, with the same anesthesia measures, those in the combined group were given etomidate (0.3 mg/kg) additionally. The patients’ perioperative ECG indicators, POCD scores, and Numeric Rating Scale (NRS) scores were compared between the two groups. Results. Compared with the ketamine group, the combined group presented significantly lower incidence of ST-T wave changes after anesthesia induction and at the time of intubation and skin incision ( P < 0.05 ), significantly lower average magnitude of ST-segment depression after anesthesia induction ( P < 0.001 ), significantly lower average magnitude of ST-segment elevation after anesthesia induction and extubation ( P < 0.001 ), significantly lower POCD incidence (6.%, P < 0.05 ), and significantly better NRS score after surgery ( P < 0.001 ). Conclusion. Combined etomidate-ketamine anesthesia can stabilize the perioperative ECG indicators of elderly RHVD patients undergoing heart valve replacement, improve their postoperative cognitive function, and reduce their pain sensation, which should be promoted and applied in practice.

Surgical techniques for aortic valve xenotransplantation

Background Heart valve replacement in neonates and infants is one of the remaining unsolved problems in cardiac surgery because conventional valve prostheses do not grow with the children. Similarly, heart valve replacement in children and young adults with contraindications to anticoagulation remains an unsolved problem because mechanical valves are thrombogenic and bioprosthetic valves are prone to early degeneration. Therefore, there is an urgent clinical need for growing heart valve replacements that are durable without the need for anticoagulation. Methods A human cadaver model was used to develop surgical techniques for aortic valve xenotransplantation. Results Aortic valve xenotransplantation is technically feasible. Subcoronary implantation of the valve avoids the need for a root replacement. Conclusion Aortic valve xenotransplantation is promising because the development of GTKO.hCD46.hTBM transgenic pigs has brought xenotransplantation within clinical reach.

Cardiac surgery under cardiopulmonary bypass in pregnancy: report of four cases

Background Open heart surgery during pregnancy is relatively rare at home and abroad, and there is a higher risk and probability of maternal and infant death. How to carry out heart valve replacement under cardiopulmonary bypass (CPB) under the premise of ensuring the safety of mother and child is the focus of attention at home and abroad. Case introduction We reported four cases of cardiac surgeries under CPB during pregnancy performed in our hospital from March 2020 to March 2021. Two of the patients continued their pregnancy after cardiac surgery under CPB. Three patients had infective endocarditis and the other one had an ascending aortic aneurysm. Three patients underwent heart valve placement with the mechanical mitral valve when the other one underwent Bentall surgery. The operations of four cases were all successful, and further follow-up evaluation of the pregnant women and fetuses showed no abnormalities. The patients' detailed information is shown in the following table. Conclusion Heart disease during pregnancy should be treated actively and proactively when the patient has obvious symptoms. Heart valve replacement under CPB will be the first choice, and this may become the primary surgical treatment for symptomatic heart disease during pregnancy.

The effect of phased written health education combined with healthy diet on the quality of life of patients after heart valve replacement

Background To observe the effect of phased written health education combined with healthy diet on the quality of life of patients after heart valve replacement. Methods One hundred-thirty patients who underwent heart valve replacement surgery in our hospital from January 2018 to January 2020 were enrolled as the research subjects. They were randomly divided into study group (65 patients, phased written health education combined with health Diet) and control group (65 cases, routine health education). The drug compliance and the degree of anticoagulant drugs knowledge were compared between the two groups in the first and second stage rehabilitation and the recovery stage. The health behavior ability and quality of life at different phases were also observed. Results During the first and the second stage rehabilitation, and the recovery stage, the drug compliance of the study group was superior to that of the control group, with statistical significance (P < 0.05). Meanwhile, the knowledge of anticoagulant drugs in the study group was better than that in the control group, with statistical significance (P < 0.05). Before intervention, there was no significant difference in health behavior ability and quality of life between the two groups (P > 0.05). The healthy behavior ability of study group for each stage was superior to the control group, the difference was significant (P < 0.05). The healthy behavior ability and quality of life showed the same results with statistical significance (P < 0.05). Conclusion The use of phased written health education combined with healthy diet in patients after heart valve replacement can effectively improve patients’ medication compliance, anticoagulant drugs knowledge, healthy behavior ability and quality of life at different stages, and is worthy of clinical application.