Preoperative Nutritional Support
Nutritional support by intravenous hyperalimentation (IVH) has been conducted in patients to improve nutritional status. Food intake was allowed in all patients, but we have never experienced the use of formulations of total parenteral nutrition because oral intake was always inadequate due to dyspnea and early satiety. When patients’ conditions were controlled well with bed rest and diuretics, they could consume more than half of the total daily amount of a hospital diet. The total daily caloric dose by IVH was 200 cal initially, and this was increased to 1,000 ± 200 cal, including 6 g of nitrogen. The duration for IVH was 5 to 8 weeks, with an average of 6.8 ± 1.4 weeks. Eighteen patients who underwent preoperative IVH were able to tolerate the volume load and maintain good physical condition.
As a consequence of nutritional support, laboratory data demonstrated significant improvement of serum total protein, albumin, potassium, creatinine, and serum urea nitrogen level (Table 3). viagra super active plus
Surgical techniques were standardized and performed with cardiopulmonary bypass under moderate hypothermia. In all procedures, potassium crystalloid cardioplegia was used for intraoperative myocardial protection. Interrupted mattress sutures were used to anchor the valve to the mitral annulus. The major opening of the valve was directed to the posterior left ventricular wall as a first choice. Concomitant procedures were conducted in 19 patients, including tricuspid annuloplasty (modified De Vega’s annuloplasty) in 17 patients, tricuspid valve replacement in 1, aortic valve repair in 2, aortic valve replacement in 1, and plication of the left atrial wall in 6.
Risk factors were assessed with the x2 test or Fisher’s exact method, and p values of less than 0.05 were regarded as significant.
Table 3—Laboratory Status of Patients Both Before and After Nutritional Support as Well as of the Patients Who Were Operated on Without Nutritional Support
|Normal Value||Patients With IVH||Patients Without IVH|
|S-total protein, g/dL||6.0-7.5||5.8 ±0.4||6.2±0.6t||6.0 ±0.4|
|S-albumin, g/dL||3.5-5.0||3.3 ±0.3||4.1 ±0.5t||3.4 ±0.2|
|S-potassium, meq/L||3.5-5.0||3.6 ±0.4||4.0±0.3t||3.8 ±0.7|
|S-cholesterol, mg/dl||120-220||153 ±24||166 ±30||160 ±21|
|S-triglyceride, mg/dl||450-1000||758 ±129||795 ±155||720 ±173|
|Hematocrit, %||38-45||34 ±5||36 ±4||36 ±5|
|Platelets, X105||20-50||24 ±6||26 ±5||22 ±4|
|Serum urea nitrogen, mg/dl||8-25||27 ±9||20±7t||29 ±10|
|Body weight, kg||43±6||46 ±5||45 ±5|