巨大左室二尖瓣机械瓣置换术后远期随访

LONG TERM CLINICAL RESULTS OF MECHANICAL HEART VALVE REPLACEMENT FOR MITRAL VALVE DISEASE WITH LARGE LEFT VENTRICLE

目的分析探讨巨大左心室机械瓣置换术后的远期疗效。方法1982年5月～2003年4月,我院为148例左心室舒张末径(LVDD)>70mm的患者实施二尖瓣机械瓣置换手术。其中男123例,女25例。平均年龄38.26±12.37岁。随访136例,总随访率97.89%,随访平均人年计6.12年。结果远期死亡21例,5、10、15年生存率为90.31%、80.27%、72.62%。术后心功能、LVDD、左室射血分数(LVEF)与术前比较明显改善(P<0.05)。结论巨大左心室二尖瓣机械瓣置换术远期疗效满意,术前LVDD、LVEF、术中二尖瓣瓣下结构的保留和三尖瓣成形术是影响术后远期疗效的主要因素。

Objective To analyze the long-term clinical result of mechanical heart valve replacement for Mitral valve disease with large left ventricle. Methods Between May,1982 and April, 2003, mechanical heart valve prostheses replacements were performed in 148 patients with left ventricular end-diastolic diameter large than 70mm(123 males, 25 females). The mean age was (38.26±12.37) year-old. 136 patients(97.14%) were followed-up for and average time of 6.12 patient-years. Results 21 patients died during the follow-up period. The survival rates at 5, 10 and 15 years were 90.20%, 80.43% and 71.62%, respectively. The heart functional status improved significantly, especially in left ventricular end-diastolic diameter (LVDD) and left ventricular ejection fraction(LVEF). Conclusion Artificial mechanical heart valve replacement are rather effectively for Mitral valve disease with large left ventricle, preoperative LVDD and LVEF, subvalvular structure preservation and tricuspid annuloplasty were major factors that effected long-term result.