老年人心脏瓣膜置换术123例

Clinical analysis of cardiac valvular replacement among 123 old patients

目的总结老年瓣膜病外科治疗结果。方法回顾性分析123例诊断为瓣膜病,并行瓣膜置换手术的老年患者的临床资料,分析其疗效、并发症及影响手术早期死亡率的相关因素。结果二尖瓣置换66例,主动脉瓣置换39例,二尖瓣+主动脉瓣置换15例,三尖瓣置换2例,Betall's术+二尖瓣置换1例,同期行其他手术共105例。早期死亡率8.9%(11/123),并发症出现率41.7%(50/123),晚期死亡3例,其中与心脏有关死亡1例,死于反复心力衰竭。随访6个月～14年,96例存活,失访13例,随访率88.1%(96/109)。心源性恶液质、心胸比>0.7是影响手术早期死亡的高危因素。结论老年瓣膜病患者病因复杂,手术死亡率和并发症发生率均高。

Objectives To summarize the outcomes of surgical treatments for heart valvular disease among the patients aged over 60 years. Methods We retrospectively analyzed the data of 123 old patients with heart valvular disease who underwent valve replacement and focused on the mortality rate, complications and the correlated factors of the early opreation death rate. Results Sixty-six patients had mitral valve replacements, 39 patients underwent aortic valve replacements, 15 patients underwent both mitral and aortic valve replacements, 2 patients underwent tricuspid valve replacements, 2 patients underwent Betall's and mitral replacement and 105 patients concomitantly underwent other surgical operations. The early mortality was 8.9% (11 / 123) and the postoperative complication rate was 41.5% ( 50 / 123). There were 3 late deaths, one case related to heart failure. Ninety-six cases were followed up from 6 months to 14 years, and the follow-up rate was 88.1% ( 96 / 109). Risk factors for the early death included the cachexia related to the heart and cardiac / thoracic ratio >0.7. Conclusions The old patients with cardiac valvular replacements had complicated pathology and tended to present higher postoperative mortality and mobidity.