1. Valvular heart surgery in Rajavithi hospital Dr.WITTAWAT PIBUL Rajavithi Hospital

2. Valvular heart disease is the most common cardiac surgery in Thailand and also in Rajavithi hospital.

3. Objective To review cases of valvular heart surgery in CVT unit, Rajavithi hospital in term of - patient’s characteristic - Pathology - Operative management - Morbidity, mortality

4. 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.

5. Results Total of 441 cases 2006 = 143 cases 2007 = 160 cases 2008 = 138 cases

6. Gender

7. Age group

8. 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%)

9. 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%)

10. Ejection fraction EFN (%) Poor (<30%) Fair (30-50%) Good (>50%) Not measure 9 (2.1%) 59 (13.3%) 350 (79.4%) 23 (5.2%)

11. Coronary angiography CAG when male >= 45 years female >= 50 years or had CAD risk factor

12. Result CAG CAG = 180 cases Abnormal CAG =23 cases (13%)

13. Abnormal CAG by age groups AGEAbnormal 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%

14. 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)

15. Rheumatic heart disease 297 cases (67%) Male 118 cases, female 179 cases

16. Mean age was 45 years

17. NYHA of RHD patients NYHAN (%) NYHA Class I NYHA Class II NYHA Class III NYHA Class IV 4(1.3%) 101 (34%) 176 (59.3%) 16 (5.4%)

18. Valve involvement

19. Operative management MV Replacement 231 cases AV Replacement 94 cases MV Repair 20 cases Combine TV Repair 10 cases

20. Choice of prosthetic valve replacement

22. Degenerative calcification group 28 Male, 30 Female Mean age 62years Valve involvement

23. Operation :Valve replacement Choice of prosthetic valve replacement

24. Degenerative MR group 22 Male, 14 Female Mean age was 56 years Operation - Valve replacement 23 cases - Valve repair 13 cases

25. 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

26. Operation : Valve replacement Choice of prosthetic valve

27. 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%)

28. 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

29. Predicted mortality rate by EuroSCORE - 4.1 % LOS 15 days Post operative LOS 11.23 days

30. 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.

31. THANK YOU