人工心脏瓣膜晚期再次替换术141例分析

ANALYSES OF 141 CASES WITH LATE REIMPLANTATION OF PROSTHETIC HEART VALVES

本文通过对１４１例人工心脏瓣膜晚期（距前次手术超过３个月）再次替换术的分析，发现死因仍以低心输出量综合征和心室颤动为主。术前心功能、术中主动脉阻断时间、同期附加手术和术中副损伤与手术死亡率直接有关。本文还对再次手术的切口选择、术野的显露方法和换瓣的操作技巧以及心脏复苏介绍了作者的经验。

One hundred and forty one patients (aged 17-70 yrs with a mean of 40.5) with 131 of bioprosthetic valve dysfunction, 5 of perivalvular leak, 3 of acute dysfunction of mechanical valve, and 2 of endocarditis underwent late (more than 3 months after the initial valve replacement) reimplantation of prosthetic heart valves, which accounted for 4.8% of the total heart valve replacements at this hospital between Sept. 1981 and Feb. 1993. The intervals between the two operations were 4 to 140 months with an average of 81.3 months. The heart functions of 4 patients were in class Ⅰ, 28 in class Ⅱ, 78 in class Ⅲ, and 31 in class IV of NYHA before the reoperation. Prostheses were reimplanted with 104 MVR, 10 AVR, 3 TVR, 22 MAVR, 1 MTVR and 1 MTAVR. The results indicated that 22 cases died in the hospital with a mortality rate of 15.6%, The causes of death were low cardiac output in 7 cases, ventricular fibrillation in 3, respiratory, renal and multiple organ failure in 2, respectively. Indications for reoperation, surgical techniques, and high risk factors for the surgical procedures were discussed.